
IVIANUAL 



OF 



OPERATIVE VETERINART SURGERl 






}>^ 



o 



BY 



a'^^'LIAUTARD, M.D., V.M 



Principal and Professor of Anatomy, Surgery, Sanitary Med- 
icine AND Jurisprudence in the American Veterinary Col- 
lege ; Chevalier du Merite Agricole de France ; For- 
eign Corresponding Member of the Societe Cen- 
trale de Medecine Veterinaire (Paris); Hon- 
orary Fellow of the Royal College of 
Veterinary Surgeons (London); Hon- 
orary Member of the Societe 
Veterinaire d' Alsace-Lor- 
raine, Etc., Etc., Etc. 

Author of '■'■Fade Mecum of Equine Anatomy i^ '•'■How to Tell 
the Age of Domestic Animals i^ ^'■Animal Castration;^ 
'''■ Latneness of Horses T Translator of '■'• Bouley 
on Hydrophobia /" of " Zundel on Diseases 
of the Foot;'''' Editor of the '■'■Ameri- 
can Veterinary Review ^ 



WITH NEARLY 600 ILLUSTRATIONS. 



( FEE G 1393 } 

New York : ^ '^^J^..^ ^'^l^ X, 



SABISTON & MURRAY, 916 Sixth Avenue,' 
1892. 



/ 



K-^ 



COPYBIGHTBD, 1891, 

By a. Liautard, M.D., V.M. 
All Rights Reserved. 



'^'; v^ 



TO 

DR. A. CHAUVEAU, 

Member of the Institute (Paris), General Inspector of tlw Veterinary Schools 
{France), Professor to the Museum of Natural History (Paris), 

As a humble token of the high appreciation of his scientific labors 

in behalf of Veterinary and Comparative Medicine, this -work is, with 

kind permission, dedicated by 

THE AUTHOR. 



PREKACE. 



If an apology should be deemed necessary for any apparent tardiness 
in the execution of the special undertaking of which the present work is 
the result, it will not be very far to seek, but may be readily found by a 
reference to the various and unceasing vocations in which the author of 
the Manual of Operative Veterinary Surgery is habitually engaged. 
The labor of its preparation has, in fact, been alternated and shared with 
that of other literary engagements of an imperative and unremittent char- 
acter, and the onerous and exhaustive duties pertaining to his collegiate 
functions, to say nothing of the demands of an extensive practice. 

Engaged for years in the work of teaching this special department of 
veterinary medicine, and having abundant opportunities, which have not 
been neglected, of realizing the difficulties which the student who earnestly 
strives to perfect himself in his calling is obliged to encounter, I formed 
the determination long since to do what lay in me to facilitate his acquisi- 
tion of knowledge; and it was then that I projected the present volume, 
and began the accumulation of material by the compilatioi of data and 
arrangement of memoranda, with the recorded notes of my own experi- 
ence, the fruit of a long and extended practice before referred to ; and of 
course a careful study of the various authorities who have illustrated and 
organized our copious veterinary literature. Moreover, haste in the pub- 
lication, and a thorough digestion of the subject and the systematic order- 
ing of material, could not be very easily combined, and a little delay in 
the issue will prove no detriment to the value of the book. 

With his own kind permission, the work is dedicated to Professor 
A. Chauveau, General Inspector of the Veterinary Schools of France, as a 
token of my high appreciation of his services as a scientist, and in recog- 
nition of his standing among the lights of our profession ; and especiall}^ 
of my estimation of his excellent book on anatomy, in which he so ably 
lays the foundation of the knowledge which constitutes the indispensable 
condition of all success in surgical practice. 



Vl PREFACE. 

I have been liberal with European authors, not only in freely cred- 
iting them with their discoveries and theories, and in many cases quoting 
literally their opinions and arguments, but especially so in adopting their 
illustrations and enriching the work with the artistic representations orig- 
inating in their's— an emphatic manifestation of my high estimate of their 
value and the skill of their execution. And it is thus that the names and 
accomplishments of Rigot, Bouley, Gourdon, Peuch, Toussaint, Cadiot 
and Zundel, of France ; of Brogniez and Degives, of Belgium ; of Hert' 
wig, Hering, Moller and Hoffman, of Germany; of Lanzillotti-Buonsanti, 
of Italy ; and of Williams and Fleming, of England, will become famil- 
iarly known to our readers. 

But while I have in great part been guided in my work by the char- 
acter of that of our predecessors, I have not restricted myself to the 
lines observed by them, or exclusively respected the authority or prece- 
dents of European surgeons, but have sought to do justice to the progress 
of American veterinarians by honoring the contributions they have made 
to our surgical knowledge ; and it is due to accident alone, and to no in- 
vidious design, if any omission or oversight has been committed, by which 
any to whom credit should be awarded have failed to receive it. 

The chapters of the Manual vt^hich treat respectively upon "Frac- 
tures" and upon "Operations on the Foot" are reprinted from my own 
previous writings. Thus, in the first instance, the remarks upon frac- 
tures, with the kind permission of the Hon. Jeremiah M. Rusk, Secretary 
of the Department of Agriculture, are extracted from an article published 
in " The Special Report on Diseases of the Horse;" and in the second in- 
stance, touching the subject of operations on the foot, I have not hesitated 
to utilize my own translation of Zundel, produced as long ago as the year 
1881. In both cases improvement has been made upon the previous treat- 
ment of these topics by the addition of numerous illustrative plates which 
accompany the text. 

In the chapter upon operations on the genito-urinary apparatus the 
reader is referred to my special work on the subject of " Castration," 
which is not included in the present volume. 

In completing the task undertaken in the preparation of the Manual, 
however perfect or imperfect may be the manner of its execution, while 
I have been influenced by a desire to effect something for the benefit of 
all classes of practitioners, including those of recent graduation, my ob- 
ject above all has been to facilitate the labors of the young student while 
industriously and anxiously toiling for the knowledge which is to qualifj'' 



him for a successful career in a useful and honorable profession ; and if 
I shall have succeeded in this object, and the success shall be certified by 
the verdict yet to be pronounced, I shall feel fully satisfied and more than 
ever encouraged to persevere in my efforts to elevate the standard of vet- 
erinary science in America. 

No toil has been spared, no effort relaxed, in the prosecution of the 
design and desire to compel the approval of the judicious, and even to 
escape the strictures of the critical, and I have not failed to seek for aid 
and counsel from competent coadjutors. The entire text has undergone 
revision, with a view to the improvement of its idiomatic structure, by my 
esteemed friend, H. D. Holt, M. D., of Jersey City, N. J., to whom I am 
also indebted for the favor of supervising the proof and overlooking the 
issue and arrangement of the various chapters ; and my publishers, Messrs. 
Sabiston & Murray, have exercised a true liberality in providing an exter- 
nal garment and garniture for the contents of the book, in all respects 
correspondent with their value and interest. To these gentlemen, there- 
fore, are due my warmest acknowledgments for whatever of internal and 
external attractiveness may characterize the Manual of Opeeative Vet- 
EEiNAEY SuEGEEY, and they are cordially and freely tendered. 

I have now only to express the hope that this contribution to the 
cause of veterinarj^ progress may be as kindly received and favorably 
judged by my colleagues as it is honestly designed to effect its object by 
me, and that any shortcomings in the execution of the work may be len- 
iently regarded. And so it goes into the hands of the public, to share the 
fate of all human ventures, for better or for worse, as its fate may be. 

THE AUTHOR. 



CONTKNTS. 



PAGE. 

Inteodtjction 1 

CHAPTER I. 

Means of Restraint 14 

Means of Securing Solipeds 14 

Derivative or Painful Method 14 

Mechanical or Restraint Method 17 

Standing Position 17 

Recumbent Position 27 

Casting with Hobbles 30 

Securing the Legs. . . 38 

Casting with Ropes 44 

Casting on the Operating Tables 47 

Means of Securing other Domestic Animals 54 

Bovines 54 

Ovines and Caprines 62 

Swine 62 

Dogs and Cats 64 

SxTRGiOAL Anesthesia 66 

Local Anesthesia 67 

General Anesthesia 70 

Accidents of General Anesthesia 75 

Accidents Incidental to the use of means of Restraint 76 

Fractures 76 

Injuries of Soft Tissues 79 

CHAPTER 11. 
Surgical Diagnosis. 

Sight 81 

Touch 86 

Hearing 88 

Smell 88 

Taste 88 



X CONTENTS. 

CHAPTER III. 

StJEGIOAL ThEBAPBUTICS. PAGE. 

Dressings 90 

Retentive Dressing 98 

Uniting " 99 

Suspensory " : 99 

Compressive Dressing 99 

Dividing Dressing 99 

Expulsive " 99 

Antiseptic " 100 

Bandages 103 

Varieties of Bandages 105 

CHAPTER IV. 

Elementaet Opebations. 

Division 125 

Incisions 125 

Dissections 137 

Puncture 138 

Reunion 142 

Position 144 

Uniting Bandages 144 

Sutures 146 

CHAPTER V. 
Opebations on the Skin and Cellular Tissue. 

Cauterization 158 

Actual Cauterization or Firing 158 

Transcurrent or Firing in Lines 160 

Firing on the Surface or " a la Gaulet " 171 

Firing in Superficial Points 172 

Objective Firing 174 

Deep Cauterization 175 

Rapid, Deep Cauterization 175 

Inherent Firing 178 

Subcutaneous Cauterization , 180 

Cauterization with the Thermo-Cautery 182 

Cauterization in other Animals 183 

Accidents of Actual Cauterization 184 



CONTENTS. XI 

Opkeations on the Skin and Cellular Tissue — Continued. page. 

Exutoriea 186 

Setons 188 

Tape Seton 188 

Regions to apply Setons 193 

Rowel Seton 197 

Trochiscus 198 

Accidents or Sequelse of Setons 198 

Ablation of Tumors 200 

Excision 201 

Ligature 205 

Elastic Ligature 210 

Removal by Tearing 211 

Puncture 211 

CHAPTER VI. 

Opkeations on Bones. 

Fractures. (Generalities) 212 

Fractures of Different Bones 239 

Dislocations 262 

Amputations 266 

Amputation of Members 268 

" " Horns, 274 

" the Tail 277 

Trephining 283 

Periostotomy 291 

Resection of Bones 293 

CHAPTER VII. 
Operations on Muscles and their Annexes. 

Caudal Myotomy 296 

Caudal Myotomy by Transverse Incisions 299 

" " " Longitudinal " 300 

" •' " Mixed " 301 

" Subcutaneous " 302 

Accidents following Caudal Myotomy 306 

Crural Myotase. Crural Myotomy 308 

Complications of Crural Myotomy 311 

Operations upon Fibi'ous Tissues 312 



Xii CONTENTS. 

Operations on Muscles and their Annexes — Continued. page. 

Tenotomy 312 

Plantar Tenotomy 312 

Accidents Following 320 

Carpal Tenotomy , 321 

Anti-Brachial Tenotomy 323 

Tarsal Tenotomies 323 

Cunean Tenotomy 323 

Peroneo-Phalangeal Tenotomy 326 

Tenotomy in Birds 337 

CHAPTER VIII. 

Operations on the Digestive Apparatus. 

On the Teeth 328 

Operative Dental Surgery 335 

Leveling of the Teeth 335 

Extraction of Teeth 343 

Filing Teeth 356 

Canine Dentistry. . .- 356 

Operations on tlie Tongue 358 

Suture 360 

Amputations. Glossotomy 361 

Operations on Salivary Glands 361 

Adenotomy •. . 361 

Maxillary Adenotomy 363 

Operations on the (Esophagus 364 

(Esophageal Catheterism 366 

The Taxis 370 

Crushing the Foreign Body 372 

CEsophagotomy 373 

Accidents Following 377 

OasProtomy. Rumenotomy 377 

Incision of the Rumen 378 

Enterotomy 380 

Paracentesis 383 

Hernia 385 

Inguinal Hernia 394 

Recent Inguinal Hernia 397 

Accidents Following 411 



CONTENTS. XIU 

Opkeations on Salivary Glands — Continued. page. 

Old Inguinal Hernia 411 

Inguinal Hernia in Geldings 418 

Crural Hernia 420 

Perineal " 431 

Pancreatic " 421 

Pelvic or Internal Hernia of Oxen .... 421 

Umbilical Hernia 425 

Diaphragmatic Hernia 439 

Ventral Hernia 443 

Eventrations 447 

Laparotomy 449 

CHAPTER IX. 

Opebations on the Respiratory Apparatus. 

On the Guttural Pouches. Hyovertebi'otomy 453 

Laryngotomy. Arytenectomy 463 

Fleming Method 463 

Cadiot Method 468 

Tracheotomy 477 

Accidents Following 486 

Thoracentesis 488 

CHAPTER X. 

Operations on the Circulatory System. 

Bleeding. Venesection 493 

Phlebotomy 498 

Phlebotomy in Solipeds 496 

" at the Jugular 497 

" at the Cephalic 499 

" on the Subcutaneous Thoraciq 501 

" at the Internal Saphena 501 

" on other Superficial Veins 503 

" in Large Ruminants 503 

" on the Jugular 504 

'• at the Subcutaneous Abdominal 504 

" on Small Animals 505 

Accidents Following Phlebotomy 506 



Xiv CONTENTS. 

Operations on the Circulatory System. — Continued. page. 

Arteriotomy 514 

Arteriotomy at the Transversal of the Face 514 

" " " Posterior Auricular 515 

" " " Median Caudal 516 

Ccurillary Bleeding 517 

Bleeding at the Palate 520 

'• '■ " Coronet.... 521 

" " Foot : 523 

Surgical Hemostasia 523 

Temporary or Preventive 524 

Permanent or Definite 526 

Physico-Chemical Hemostatics 526 

Surgical Hemostatics 530 

CHAPTER XI. 

Operations on the Nervous Apparatus. 

Plantar Neurotomy 541 

CHAPTER XII. 

■Operations on the Genito-Urinart Apparatus. 

Catheterism of the Urethra 558 

Urethrotomy 558 

Preputial Urethrotomy 561 

Scrotal " 561 

Ischial " 563 

Cystotomy 565 

Lithotrity 565 

Amputation of the Penis 569 

CHAPTER XIII. 
Operations on the Foot. 

Anatomy 576 

Diseases and Defectuosities 583 

Vices of Conformation 583 

Instruments 589 

General Operations 590 

Dressings . . 591 



CONTENDS. XV 

Operations on the Foot— Continued. page. 

Diseases. Canker of the foot 591 

Corns 607 

Sandcracks 616 

■Calk 627 

Punctured "Wounds of the Foot 629 

Contracted Heels. Hoof Bound 640 

Diseases of the Frog 665 

Keraphyllocele 668 

Laminitis 669 

Navicular Disease 694 

Quittor 702 

Cutaneous Quittor 703 

Tendinous Quittor 706 

Sub Horny Quittor 711 

Cartilaginous Quittor 714 

CHAPTER XIV. 

Opep.ations on the Eye and Ear. 

On the Eye. 

Operations on the Accessoi'y Ocular Organs 739 

Traumatic Lesions 740 

Solutions of Continuity 740 

Defective Congenital Conformations 741 

Pathological Growth and Caries of the Membrana Nictitans . 742 

Operations on the Lachrymal Apparatus 743 

On the Caruncula 743 

On the Lachrymal Ducts 744 

On the Lachrymal Canal 745 

Operations on the Essential Organs of Sight 746 

Extraction of Foreign Bodies on the Surface of the Globe . . . 748 

Paracentesis of the Cornea 748 

Staphylonna 749 

Cataract 749 

Amputation of the Eye 754 

Ocular Prothesis 755 

On the Ear. 

Amputation 756 



Xvi CONTENTS. ^ 

CHAPTER XV. 

PAGE. 

Diseases of the Withebs 759 

Excoriations 765 

Warm (Edema : 765 

Hematoma 766 

Core or Stickfast 766 

Abscess 769 

Wounds 770 

Diseased or Fistulous Withers 771 

Terminations of Diseased Withers 774 

Diseases of the Poll 779 

Excoriations, CEdematous Swellings, Core, Bloody Tumors . . 781 

Cyst 781 

Abscess 783 

Poll Evil 784 



INTRODUCTION. 



Under the designation of operative surgery is understood that 
department of medical science and practice which includes the 
external and instrumental manipulations required in the treat- 
ment of surgical diseases and accidental injuries or deformities; 
or perhaps it might be succinctly defined as surgical science me- 
chanically applied. 

The two branches — the science and the art — which constitute 
the study of operative surgery cannot, of course, be dissociated 
in a treatise on the general subject, and it will therefore be neces- 
sary, as we proceed with the detail of our observations, to give 
due consideration to the aetiology, the symptomatology, the pathol- 
ogy and other characteristic features of certain diseases, in their 
relations to the indications of treatment and the manipulations 
which they involve at the hands of the surgeon 

Viewed from the standpoint of comparative importance ia re- 
spect to the value of the results of human and veteiinary surgery, 
as relating to the vital status of the patients who become respect- 
ively the subjects of both — the human being and the quadruped 
races — veterinary surgeiy must of course consent to occupy the 
subordinate place ; a fact, however, by no means tending to dis- 
parage the value or the just estimation of the calling of the scien- 
tific veterinarian. 

In human surgery the one paramount result held up to view 
is the prolongation of the life of the patient. This is a consum- 
mation to be achieved regardless of any considerations of cost or 
trouble, while in veterinary siu'gery the prime motive is the res- 
toration of the patient's interrupted ability to fulfil his function 
as an animated machine for supplying a certain amount of valu- 
able force. For these reasons the scope of veterinary practice is 



2 INTKODUCTION. 

a circumscribed one, in comparison to that of human surgery, by- 
having the aim and being brought to the test of mere econoi^ic 
utihty. While the human life is prolonged at any cost, moreover, 
the treatment of the animal is always supplemented and influ- 
enced by the consideration that if curative efforts fail, the suffer- 
ings of the patient may be terminated by the administration of 
a prescription which will at once release him from pain and de- 
prive him of hfe, with the full sanction both of self-interest and 
benevolent feeUng. 

Another element which operates to define the sphere of the 
veterinary surgeon is the natural disinclination of the owner of 
a sick or disabled animal — perhaps a man of limited pecuniary 
resources — in a tedious and unpromising case, to add to the ex- 
pense of surgical attendance the cost of the unremunerated 
" keep " of his disabled and unproductive servant. 

It ought to be true, as a matter of course (perhaps it is so in 
point of fact), that no man of intelligence and integrity will as- 
sume the duties and responsibilities of surgical practice without 
the due preparation and equipment, which is only to be acquired 
by conscientious study and competent knowledge of medical 
science at large. Especially and indisj)ensably a surgeon must 
be an accomplished anatomist. His knowledge must be thorough 
and practical in the several divisions of anatomical science — he 
must possess a familiar a^cquamtaxice vrith. descriptive anatomy; 
he must be fully instructed in surgical anatomy or the anatomy 
of regions ; he must have mastered the last chapter in pathologi- 
cal anatomy ; and if there are any other kinds of anatomy, he 
must master them all, and then he will have become an anatomist 
in fact, and qualified to practice surgery. Yes; a surgeon must 
be an Anatomist. 

And it ought to go without saying, that only a surgeon should 
practice surgery, whether his patient be biped or quadruped. No 
untrained layman should presume to wield the knife and the 
cautery with their associated arsenal of weapons and other appli- 
ances for the subjugation of the enemy whose assaults it is the 
special province of the surgeon to repel. An ignorant operator 
may easily become, himself, a more dangerous "lesion" than some 
of those which he presumes to treat. The man who can cut into 
the living, and usually hypersensitive, flesh of a suffering animal, 
without knowing what tissue or organ he is attacking, what artery 



INTEODUCTIOK. if 

he is likely to sever, what nerve to wound, what organ to lacerate, 
what function to paralyze ; who would essay the operation of neu- 
rotomy without knowing where to look for the plantar nerve ; who 
would undertake a case of vaginal spaying in ignorance of the 
location of the flying ovaries; or who woiild operate for strangu- 
lated hernia unaware of the mode of avoiding the infliction of 
injury upon the posterior abdominal artery — such a man, if to be 
found, should simply be subjected to an odium which should 
ostracise him from honorable and equal association with others 
of his species, besides being held criminally amenable to the law 
providing penalties for the perpetrators of cruelty to animals 

These reflections may be unnecessary, but it is aU too true 
that our domestic animals too often become the victims of worse 
than brutal masters, who take advantage of their helplessness and 
inferiority to inflict upon them cruelties so gross and aggravated, 
that right-feeling men are often compelled to blush to call them 
feUows. It is no excuse for this that it is done through the 
agency of a pseudo-surgeon : such a plea merely doubles the 
number of the wrong-doers. 

In offering these suggestions, and in formulating the informa- 
tion which follows, derived from the experiences of many studious 
and observant men, and which in their aggregate and connected 
form constitute the substance of this volume, it is assumed that 
it is only from competent and quahfied minds that the apprecia- 
tion which it hopes to merit and to receive must come, and we 
trust that to the extent of its justice and truth it will not be 
withheld. 

With the skill of the expert anatomist must be associated, of 
course, the necessary mastery of therapeutics and a familiar knowl- 
edge of special and general pathology^ and all should be supple- 
mented by a knowledge of the theory and practice of the farrier. 

The science and the application of the laws of hygiene, so 
generally, indeed almost whoUy, ignored by our fathers, and so 
largely a discovery of the present time, will never be overlooked or 
depreciated by the genuine surgeon ; and while possibly the effects 
of meteorological influences may have become of less importance 
than they were considei'ed to be in times gone by, a careful ob- 
servance of their phenomena will never be a useless item of acqui- 
sition. The fullest attention to the theories and appUcation of 
what may be denominated the science of antisepsis, and the adap- 



4 INTROBUCTION. 

tation of antiseptic measures, now so universally and unintermit- 
ting an adjunct to all medical and surgical practice, and so utterly 
indispensable in the departments of dressing and nursing, and so 
often an available and valuable aid in the very act of operating, 
must be considered now to have become an incorporated and con- 
stituent department of the domain of surgery, and medicine as 
well, and the cultured veterinarian will of course so regard it in 
his practice. 

Without being necessarily a practical worker at the anvil, the 
surgeon, as we have intimated, must acquire a familiar acquaint- 
ance with the theories and the art of the farrier. No one can 
place too high an estimate upon the importance of the position 
occupied by the foot among the anatomical regions where lesions 
may be expected to occur, and whereas the shoe becomes practi- 
cally identified with the living member, and is, in use, a portion of 
the hoof itself, by the act of nailing the shoe and the hoof together 
the inference becomes palpable. An occasion may easily arise 
when a serious blunder in treatment may be traced to a previous 
blunder in diagnosis, which again may be referred to an earlier 
blunder still, which has consisted in neglecting to examine the 
foot, and the shoe which has injured it. What is the status, in 
respect to his market value, of a horse with poor feet, or whose 
good feet have been ruined by bad shoeing ? So the veterinary 
surgeon, though not required to be able to make a set of shoes, 
should be expected to know how they ought to be made and fast- 
ened. And when a special shoe is required for the correction of 
a deformity, or as indicated in some diseased condition of the foot, 
it will of course become the exclusive province of the surgeon to 
dictate the whole process of forging and fastening, and to see that 
his instructions are not ignored. 

Besides the special scientific attainments to which we have 
referred, there are many other qualifications which must enter 
into the character of the good and skillful surgeon, in order to 
round it into true symmetry and proportion. Bouley remarks 
that "he must not only be a man of science, but a man of art," 
meaning, we suppose, that he should not only possess knowledge, 
but know how to make it available. First, he must possess the 
faculty of knowing how to gauge the necessity of his interference, 
with its manner and its duration; or, on the other hand, whether 
any interference is necessary, and whether the true indication is 



INTRODUCTION. 5 

not to refrain entirely from active measures. The result of bis 
decision will afford a good test and gauge of the extent to which 
he has profited by bis clinical and theoretical study. He is a 
sound philosopher who can wisely determine when to let alone, in 
opposition to the temptation to do something. 

The acqmsition of manual dexterity is an accomplishment of 
prime importance and should be acquii'ed, and can only be earned 
by dibgent practice upon the cadaver, or, what perhaps is more 
effectual, besides being in itself real work, by utilizing every op- 
portunity of performing minor operations, under suitable instruc- 
tion, upon actual patients. Of course, expertness without practice 
is impossible. It is not fully correct, perhaps, to speak of manual 
dexterity in the singular number. The dexterity required shovdd 
be bi-manual or ambi-dexterity, and any surgeon who has not 
mastered the art of using both hands indifferently, though he may 
have learned all else pertaining to his profession, lacks yet one 
thing. Cases will continually arise in which the inability to change 
hands may interrupt the progress of an operation and involve the 
practitioner in great inconvenience, if not embarrassment, and 
possibly prejudice the case itself. 

Coiirage and coolness, with patience, are essential qualities of 
temper in an operating surgeon. To become alarmed and lose his 
balance on the occurrence of some untoward incident, or the ap- 
pearance of some unlooked-for abnormal development or compli- 
cation, or to give way to a spirit of impatience because of unex- 
pected delays, or, especially, to resent the fractious movements of 
the suffering animal, writhing under the knife or the glowing 
cautery, is both unprofessional and unmanly. The terms cour- 
age, coolness, patience and kindness should describe his state of 
mind while operating. 

The whole axiom of Asclepiades, cito, tuto and J ucunde, re- 
veals the entire scheme of conduct proper for the sui'geon under 
all circumstances. Every movement of the surgeon should be 
prompt and precise. Indeed, by operating rapidly he shortens 
the duration, and consequently the sum of the inevitable pain, 
and thus diminishes the anguish of a long and torturing infliction 
on behalf of the patient. The maintenance of his own self-possession 
will make him master of the situation, and assure a neat and ar- 
tistic finish to his task, with no imnecessary divisions of tissues, 
no mistaking of localities, and generally with no betrayals of 



6 INTRODUCTION. 

doubt and hesitation or awkward and aimless manipulations, such 
as mark the attempts of the tyro and the novice. The confidence 
and facility with which each movement is accomplished will not 
fail to impress favorably those who are spectators of the opera- 
tion, and to react favorably and profitably for the operators. 

Although, of course, the qualities of accuracy, neatness and 
rapidity must favorably impress the spectator, as well as benefit 
the patient, it must not be forgotten that the true success of the 
surgeon must find its evidence in the favorable result which 
finally crowns his work. If that is assured, it is but a small 
matter whether it is or is not applauded while in progress — the 
applause will follow, in any case. 

We quote from Bouley, in the Dlctionnaire de Medecine et de 
Chirurgie Vtterinaire, where he remarks, on another important 
practical point: "The operative function of veterinary siu'gery 
requires, on the part of the man who practices it, a certain cor- 
j)oreal vigor, associated with sufficient agility to be able effectually 
to overcome the resistance of animals under torture, and counter- 
act the efforts and avoid the injuries they are always so prompt 
and often so dexterous to inflict upon those who are causing them 
pain. The veterinary surgeon must be cool-blooded and patient, 
never losing his presence of mind while directing the manipula- 
tions, often so difficult and so dangerous, which are necessitated 
at his hands, especially when the large domestic animals are under 
treatment. He must then — always, in fact — be prepared for all 
difficulties and eventualities that may arise, whether before, during 
or after an oj)eration, and he must inspire confidence in his assist- 
ants by using full precautions for their safety and for his own, in 
his defensive dispositions against the dangers to which they are 
exposed " 

A surgical operation, as elsewhere described, is a mechanical 
action, practiced with more or less rapidity upon the living body, 
according to certain rules, either with the hand alone, or assisted 
by instruments, with a therapeutical or a prophylactic object in 
view, whether primarily necessary or facultative, of a prophylactic 
nature. 

It is especially as therapeutic measures that operations are 
necessitated in. the treatment of diseases and injuries; as, for ex- 
ample, in the case of the removal or extirpation of diseased or 
altered parts, whose morbid action injuriously affects the general 



INTRODUCTION. i 

health or prevents recovery from a pre-existing disease. This 
class of operations includes the opening of abscesses, the extirpa- 
tion of gangrenous parts, or of necrosed or carious bone ; or again, 
for the modification of the nature of a traumatic lesion, in order to 
stimulate cicatrization, as in the opening of a fistulous tract, or 
the resection of an ulcerated surface; or when the economy is to 
be reheved from the presence of a foreign body, or the abnormal 
product of a natural function, as in cases of oesophagotomy, or 
of calculi of the bladder, or of the saUvary ducts. Operations have 
also their prophylactic uses, esx^ecially in the various forms of in- 
oculation and vaccination as anticipatory and preventive of infec- 
tious diseases. They find their further obvious indications, again, 
in remedjing physical lesions when apphed to fractures, dislo- 
cations, deformities, and the endless hst of accidental injuries, 
wounds and hurts of every kind and degree. And, finally, they 
have their justifiable use in mutilating the larger domestic animals, 
designed for purposes of labor as beasts of burden or draught, in 
improving their adaiDtabihty by castration or spaying, or as prop- 
erly termed, '"altering." 

Thus the general pui-pose of an operation is to palliate, cure 
or assist in the recovery of surgical diseases ; to prevent diseases, 
and especially such as are known to be contagious ; and so to 
modify the condition of the domesticated animals as to enhance 
their usefulness and value to their human owners. 

In medical nomenclature, operations are variously designated 
according to the methods and characteristic manipulations attend- 
ing their performance, and the objects which they are designed 
to accomplish. Thus: 

(a) It is a liffht operation when superficial tissues or those of 
secondary importance are involved, like that of venesection, or the 
simple puncture of a vein. On the other liand, it becomes serious 
when it is performed upon important organs, or involves extensive 
and compHcated structures, as that for the reduction of strangu- 
lated hernia; the removal of the lateral cartilage of the foot in a 
case of quittor; the operation for chronic champignon, etc., etc. 

{b) Operations are also drt/ or bloodless when accompanied by 
little or no hemorrhage; and sanguinary or bloody when, on the 
contrary, much hemorrhage attends any of their various steps. 

(c) Again, they are simple or complicated according to the 
extent and multipUcity of the tissues or regions forming their 



8 INTEODUCTION. 

seat ; simjyle if performed by a single manipulation, complicated 
when requiring several distinct or separate stages for their exe- 
cution. 

(d) Operations are called regular or determinate when per- 
formed according to rules in relation to the disposition of the 
parts, and, in general, upon sound structures; and they become 
irregidar or casual when the manipxilations are extemporized to 
meet the emergencies of the case, the necessity of the situation 
and the unanticipated complications which may arise while opera- 
ting, as particularly in cases of the removal of tumors. 

(e) They have also received various designations indicative of 
the time chosen by the surgeon for their performance ; or made 
imperative by the circumstances of the case ; or according to the 
object specifically in view : thus they are iirgent or of 7iecessity 
when a fatal event would be the alternative of delay, and imme- 
diate treatment becomes imperative, as the condition of the 
jDatient's survival, as in operation for the reduction of strangu- 
lated hernia, or that of tracheotomy in a case of threatening suf- 
focation; and in cases beyond hope of complete recovery, they may 
become necessary, indispensable, useful or palliative, according 
to the degree in which they may be made available as a means of 
relief, and may tend to the temporary respite of the sufferer, and 
in some degree improve his value by measurably enhancing his 
ability to continue to labor with some degree of comfort before 
he is overtaken by a final and total disabihty. 

There is another class of operations which justly deserves to 
be totally discountenanced and ignored, and in fact are fit objects 
for penal prohibition. They are known as operations of fantasy 
or fashion. They are without real utility; are abortive attempts 
to improve upon the symmetry of nature ; are devised simply to 
satisfy a mere whim of affectation; are in wretchedly poor taste; 
and probably subject their victims to a more aggravated and j)ro- 
tracted species of torture than any other form of wound known to 
veterinary surgery. There are sometimes conditions, however, in 
which they may lose their alleged aesthetic pretext and their ar- 
tistic character, and the object of their performance may be 
regarded as properly within the legitimate and beneficial sphere 
of professional work. 

The settlement of the point of the time, in connection with 
any piece of surgical work, is not always one of mere secondary 



INTRODUCTION. 



importance in deciding the matters pertaining to the details of 
an operation. ^Vhen there is any option in the case it pertains 
wholly to the siu'geon to determine the question. And when the 
period of abeyance has terminated by his decision in fixing the 
day and hovu' when the contemplated treatment is to be applied, 
the optional time becomes changed to the selected time. Of course 
it is not always left to the option of the practitioner to select the 
moment for the accomphshment of his task. He must be gov- 
erned by the nature of the case, and may be left without the 
opportunity of exercisiag any discretion in the matter. The 
urgency of the occasion may be extreme, with no interval allow- 
able for deUberation or choice, and the only available time, the 
peremptory present, must be accepted as that of necessity. 

The operation beiag now obUgatory, and the case understood, 
the surgeon's next thought is the choice of the locality of the 
operation, and that being finally decided, the point of selection 
has been reached. The case may easily present such features that 
this point becomes too obvious for hesitation by becoming that of 
selection as well as that of necessity, as indicated by the seat of 
the lesion or diseased process. With traumatic cases, there is, 
of course, but a single point of interest — it is ih.e jioint of injury I 

In surgical phraseology the terms method and procedure are 
often used convertibly. There is between them, however, a dis- 
tinction which, for the sake of precision, must not be lost sight of. 
By method should be understood the piincipal and primordial 
mode by which the operation is performed, while by p>rocedure is 
meant the special modifications and successive stages by which 
the manipulations of the operation itself are regulated. For ex- 
ample, in the removal of a vesical calculus there is one method by 
hthotrity and another by extraction, and with both are involved 
the insertion of instruments into the urethral canal, one being the 
procedure with the catheter, and the other the procedure by the 
injection of tepid water. Castration with clamps is a method, 
when comj)ared to double subcutaneous twisting {bistournaye) or 
to torsion; and it is performed by two procedures, that by covered 
and that by uncovered testicles. 

There are several important points which demand special at- 
tention at the hands of the surgeon before beguming an operation. 
Having finally reviewed the situation, and esj)ecially having men- 
tally rehearsed the anatomical disposition of the region and the 



10 INTKODUCTION. 

pathological character of the lesion, with the necessary details of 
the work before him, not forgetting to anticipate possible acci- 
dents and compHcations ; and being assured that his arsenal of 
instruments, dressings, etc., is ample and in good and available 
order, with a liberal provision of sponges, antiseptics, etc., and 
duplicates of such of the instruments as are liable to be broken 
or otherwise disabled, the condition of the patient should then be 
ascertained. It will, of course, have been thoroughly understood 
by the surgeon previously, but it is always among possibilities 
that even at the appointed moment for operating, some changes 
may be discovered or some new cii'cumstances developed which 
may modify or contraindicate the entire proceeding. 

Some final preparation of the patient is always necessary. One 
item of this consists in clipping the hair from the skin over the 
seat of the operation, and thoroughly cleansing the part. In 
some cases it is necessary to soften the tissues by means of poul- 
tices, baths or wet bandages. There is also a constitutional and 
general preparation which must not be neglected, with a view to 
so modify the organism as to improve the ability of the animal to 
withstand the shock of the operation. If weak and debilitated, 
his strength and condition must be improved; if of an irritable 
and nervous disposition, precautions must bo taken to control it. 
A comparatively low diet is almost always a salutary measure, 
and sometimes even complete diet an essential preliminary to an 
oi^eration, and the surgeon must assure himself that they have 
been properly taken into consideration. 

In many cases the surgeon needs the co-operation of assistants, 
either professional men or laymen. The aid rendered by a profes- 
sional brother or by a student of medicine will of course be such 
as wlU be assigned to him by the responsible surgeon, and cannot 
be specified here — it will vary with every case. The facility and 
•success of an operation will be greatly promoted by their intelli- 
gent and sympathetic aid, which will be quite of an indispensable 
character. In enlisting laymen as assistants, it will of course 
devolve on the surgeon to instruct them as fully as possible in 
the nature of the services expected from them ; and in making his 
selection of individuals it v.dll be an important point gained if he 
can obtain those who are accustomed to the management of ani- 
mals, and who are expert in handling and successful in controlling 
them. 



INTRODUCTION. 



11 



There is still another party to be considered while referring to 
the study of "preparation." It is neither the animal, the surgeon, 
the assistants, the instrument case, nor the lint and bandages. It 
is the owner of the ailing animal. And to " prepare " him for the 
event is oftentimes a performance requiring a larger amount of 
judgment, tact, knowledge of human nature and jDatience than 
the average man possesses. On the one hand there are those of 
the optimist class who have quite an unwarranted opinion of the 
power of surgery, and who, in despite of the most unfavorable 
prognosis, insist upon a resort to the knife, even upon inadequate 
occasions. And' on the other hand are those who interpret any 
suggestion which involves a solution of continuity professionally 
proposed, however artistically consummated, as only a mild form 
of sentence of death to the patient. But however antijDodean 
may be their views in other respects, they are in common quite 
assured that for an ojaeration which fails to restore the dilapidated 
patient to a condition a httle better than new, whatsoever may 
have been the accident or lesion which he may have encountered, 
and whatsoever may have been the skill and intelligence exhibited 
in the treatment of his wounds or ailments, the only legitimate 
and orderly conclusion is a suit at law for malpractice. It is the 
function of the doctor to cure disease ; if he treats disease without 
curing it, he is an incompetent; this is the irrefragable logic! 
Though the hving animal had failed to return any remuneration 
for his subsistence, and for the care lavished (?) on him during 
the period of his disabihty, yet when reduced to the state of a 
cadaver he should be compelled, if possible, in an indirect way to 
net his bereaved owner a sum hkely to prove largely anodyne to 
the poignancy of the grief which the loss of so much property 
had excited. 

But aside from this, the owner of the Hving property, the value 
of which is about to be jeopardized, is entitled to a full and candid 
statement of the nature of the case, with its possibihties and its 
dangers, and it is in the interest of the sui-geon himself to observe 
perfect frankness with his employer — not, however, to the extent 
of compromising his position as doctus in the case, or foregoing 
his self-respect by making concessions upon points of scientific 
acqviisition to a layman, however generally iutelhgent or specially 
interested. The surgeon mxxst assert himself as the representa- 
tive and exponent of an honorable and learned profession, able 



12 INTRODUCTION. 

and prepared to acquit himself of his just responsibilities; and, 
indeed, it is in this assumption by him, with the conceded assent 
of the owner, that the virtue of the contract lies, which binds the 
two parties with equal force, moral and legal. 

This point, being understood and settled, should be looked 
upon as furnishing the best preparation which the owner can ac- 
quire, and he will need no other when he is thus made to under- 
stand that he must have full confidence in the skill which he has 
called into requisition, and must be guided by its imphed guar- 
antee that every possible precaution will be taken to carry the 
patient through his trouble ; and that if accidents of any nature 
should occur, when not incurred through carelessness or error, 
the risk is the owner's, and he alone must assume it. Such an 
understanding on the part of the owner will impose u^Don the 
honorable surgeon an imperative sense of the conscientious care 
with which his task should be performed, while at the same time 
it will relieve his mind from the laressure of a possibly embarrass- 
ing anxiety while engaged in his work, and it cannot fail to be of 
advantage in various ways to all the parties concerned. 

Minor matters, such as the condition of the weather, the 
time of day, the selection of a place, the position which the oper- 
ator must assume for himself, with that which he assigns to the 
patient — these are points which are also to be carefvilly taken into 
consideration. They have, one and all, more or less influence on 
the facilities of execution of an operation, and perhaps also on the 
results that may follow it. 



CHAPTEE I. 
MEANS OF RESTRAINT. 

The final preliminary before operating upon animals, is to place 
the patient in such a condition of restraint as will assure the entire 
safety of the surgeon and his assistants from injury likely to result 
from the violent struggles of the terrified and suffering creature. 
The severity or the duration of the operation fiu-nishes no acciirate 
measure of the necessity of the restraint, or of its continuance or 
degree. Any unusual or violent aggressive treatment will excite 
his fears, and consequently his opposition, and whether the occa- 
sion be a painful and protracted dissection, or the simple apj)hca- 
tion of a dressing, the surgeon may usually rely on the strenuous 
resistance of the patient. It is of little account that there are 
differences of dispositions in horses, as in men. With any un- 
reasoning animal the case is the same, and with the excitement, 
the anxiety, and no doubt, a vague terror of something unknovsm 
impending, too often qvdte explainable by the treatment to which 
he has been long accustomed at the hands of an unfeeling owner, 
he is prompted by the mere instinct of self-preservation to defend 
himself with such means as nature has taught him to use. The 
necessity of enforcing a passive condition in the animal being thus 
apparent, it ought not to be necessary to say that the means of 
accomplishing it should be employed with reserve and moderation, 
especially when they are painful in themselves, and that no man 
claiming to be the possessor of humane iastincts will permit 
himself to increase the severity of their appHcation by supplement- 
ary ill treatment, in the infliction of "punishment," upon the 
alarmed and suffering brute, a course which is quite likely, more- 
over, to be as ill judged as it is otherwise reprehensible, from the 
fact that in most instances its effect is contrary to its intention, in 
aggravating the evil it would remedy. It should never be forgotten 
how easily the most fractious and timid animal may sometimes be 
controlled by kindness and patience, and his agitation soothed by 



14 MEANS OF KESTRAINT. 

the sound of a familiar voice with which he has become accustomed 
to associate acts of gentleness and friendliness. Under any cir- 
cumstances, a habit on the part of the surgeon, of brutal treatment, 
the exhibition of a bad temper, in the indulgence of fits of anger, 
leading to acts of cruelty in the iafliction of unnecessary paia on 
his dumb and helpless victim, is not only ia every way useless, as 
being of no possible advantage in any direction, but tends to a 
degree of moral harm in those who are thus culpable for which no 
counterbalancing benefit can be imagined, and which certainly can 
never facilitate the remedial effect — but quite the reverse — of the 
pending operation. 

A benignant method of controlling animals for the special 
purpose for which treatment by the surgeon is invoked, is not, 
however, alone sufficient, and it is thus that a resort to effective 
means of physical restraint becomes unavoidable. 

These are of two kinds : one consists in inflicting upon some 
given part of the body, more or less remote from the seat of the 
operation, a severe and continuous pain, which, by a process of 
derivation, reduces that which is incident to the steps of the 
operation, by distracting or diverting the consciousness from the 
influence of the new suffering, against which he feels resistance 
would be in vain, to that of which he is sensibly cognizant, and 
thus the animal submits himself, with a comparatively voluntary 
surrender. 

The other kind consists of restraints proper, and are constituted 
of mechanical devices for securing immobihty by the process of 
overcoming opposition by means of a dominating physical force. 
Their use is not affected by the position of the subject, and they 
are therefore applied in both the upright and decubital posture. 
The first comprehends the derivative or painful method of Peuch 
and Toussaint's division ; the second, the method by direct me- 
chanical restraint. 



MEANS OF SECURING SOLIPEDS. 

A. — Derivative or Painful Method. 

This method is in very common use, and usually proves to be 
sufficiently effective to secure a degree of quiet and passi\dty in 
the patient for the safe performance of many light oj)erations. 
Under some circumstances it is used in connection with the means 



SECURING SOLIPEDS. 15 

of direct restraint. The instruments mostly employed in the first 
method consist of the twitch, the old fashioned barnacle, and 
the gag. 




Fig. 1.— The Twitch. 

The twitch is the instrument most commonly used and, un- 
fortunately, too commonly abused. In horses, it is sometimes 
applied on one of the ears, and sometimes on one of the hps ; and 
is very severe in its action, wherever appUed. 

In applying it, the operator, passing his right hand through 
the loop of cord of the instrument, grasps the tip of the upper or 
the mass of the lower Hp, leaving the loop to sHp over his fingers 
close to the skin which it then encloses, and with his left hand 
turns the handle of the instrument until the cord is sufficiently 
shortened to form a true Hgation of the tissues which it circum- 
scribes. The paiu caused by this constriction may be graduated 
by the rotation of the handle of the instrument. When iu place 
it is either held by an assistant or tied on the halter. If the 
animal proves to be especially refractoiy under the infliction, the 
assistant should be cautioned against aggravating the trouble by 
forcibly dragging upon or jerking the instrument, violence of 
that nature becoming in some instances the cause of severe injuries 
to the muscular or nervous structm-es of the Hps. We have 
ourselves met with several cases of labial paralysis resulting from 
such an improper and repeated application of the twitch. Some- 
times the length of the wooden portion of the instrument is con- 
siderably reduced, varying in its application in such a way that 
when the open loop is placed on the lip the wooden part which 
takes the place of the handle is placed on the lips through it, and 
the cord is twisted by turning it. 

The barnacles are formed of two articulating branches, made 
of either wood or iron, with sundry notches at one end and a ring 
at the other to fit into the notches. The degree of pressure re- 
q^uired is regulated by shifting the ring until the projDer notch is 



16 



MEANS OF BESTRAINT. 




Fig. 2.— Short Twitch. 



ascertained. The iron instrument is severe in its effects, probably 
more so than the twitch, but is less easy of application. In apply- 
ing the barnacles, the surgeon grasps the upper lip, and placing 




Fig. 3.— Iron Barnacles. 



each of the branches severally on opposite sides of the organ, 
brings the ends together, immediately fixing them in place at the 
desired point of pressure, and secures them by fitting the ring 
into the proper notch. 




Fig. 4. — Wooden Barnacles. 

The wooden barnacles are made with circular sharp ridges cut 
in both branches in order to intensify the pain, the ends, when 
they are approximated, being secured by means of cords. 

The gag is a means of derivation used principally in Central 
Europe. It consists of a cord about one-quarter of an inch in 
diameter, which is placed in the mouth, and passing upward on 
each side of the face, is tied on the top of the head. This is twisted 
to any degree of tightness by means of a small, round piece of 
wood, which is passed between the cheek and the cord, the result 
being excessive traction upon the commissure of the lips and great 



SECURING SOLIPEDS. 17 




Fig. 5.— The Gag. 

pain to the animal. Lacerations of the commissure, or wounds of 
the skin at the poll are to be anticipated if this manner of punish- 
ment is not guardedly used. 

There are besides these some milder appHances which must 
not be overlooked. Among them is the repeated pricking of the 
tip of the nose with a pin, and the introduction of foreign bodies, 
such as musket balls in the ears. The origin of this last method 
dates back to 1607, when Uttle round stones were recommended 
for the same object. When musket balls are used, holes should 
be drilled through them for the insertion of a string, in order that 
they may be withdrawn when necessary. 

^. — Mechanical or Restraint Method. 

The means employed in this method vary according to the po- 
sition, whether upright or recumbent, in which it is desirable to 
confine the animal during an operation. 

STANDING POSITION. 

The necessity of imposing restraint upon the patient while 
under treatment in the standing position arises not alone from the 
danger of injury to the operator and his assistants, from the biting 
and kicking of the excited animal, but because he is so thoroughly 
impartial in the distribution of his attentions that he even requires 
protection from his own violence, and his own flesh must be guard- 
ed from the contact of his own teeth. 

They are usually resorted to in order to facilitate operations 
of comparatively trifling importance, and which are not of a par- 
ticularly painful nature, or are of easy and rapid execution, or 



18 MEANS OF RESTRAINT. 

under circumstances when the animal can be controlled by being 
merely held by the head against a wall, or with the hind quarters 
in a corner, or perhaps tied to a wall, a post, or a tree. Certain 
minor precautions are necessary on these occasions. For exam- 
ple, the groiind on which they stand must be smooth, though not 
slippery ; of a good holding character, and neither too hard or too 
damp, in order to avoid falling, or sHpping, or other possible ac- 
cidents. Attention to these matters will be of great benefit to the 
operator by leaving him a good foothold, with facilities for free- 
dom of movement, and more at Hberty to guard himself against 
his patient, unexpected changes of attitude. 

The means by which the movements of the head are kept under 
control are the halter^ the bridle, the hridoon and the cavesson — 
instruments which need no description here. If the animal is left 
unconfined, the assistant having passed the rope of the halter or 
bridoon through his mouth, holds him close to his head, places 
himself in front of him, or slightly on one side, and being atten- 
tive to every movement the animal may attempt, anticipates it, by 
pulling the head downwards if the animal is about to rear, or rais- 
ing it upwards to prevent him from kicking with his posterior legs, 
or inclining it to one side or the other, as the animal moves it in 
one or the other direction. 

An animal should never be tied with the halter-rope in his 
mouth or over his nose. There is danger in both methods of se- 
rious accidents, in case of a violent backing or jerking of the 
head. In one case the result might be a section of the tongue, 
and the other might involve a fracture of the maxillary. For simi- 
lar reasons the bridle is also dangerous. The height at which the 
head shotdd be secured must vary with the movements attempted 
by the horse. Thus, to prevent him from rearing or striking with 
his fore legs, it should be placed low, but high when it becomes 
necessary to guard against his elevating his posteriors in order to 
kick with his hind legs. 

To protect his head against possible self-inflicted blows result- 
ing from his defensive struggles, and to prevent him from seeing 
surrovuiding objects likely to alarm him, are precautionary items 
of not a Httle importance, and the employment of the mask or cap 
(Fig. GC) is very effectual for that purpose. Fractious patients, 
dangerous to handle and difficult to control, often become perfectly 
quiet and thoroughly docile on finding themselves involved in dark- 



SECUBINO SOLIPEDS. 



19 




Fig. 6.— C, the Cap. O, the Cradle. 



ness, and submit to tlie necessary manipulations of the sui'geon with- 
out further resistance. When a proper cap is unobtainable a bridle 
with blinders can be substituted, or a blanket placed over the head. 
Biting the attendants may be prevented by applying a muzzle, 




Fig. 7.— The Side Bar. 



20 MEANS OF EESTRAINT. 

and he may be protected from his own teeth by the use of the 
cradle (Fig. 60) or beads, or the side bar (Fig. TAB). With the 
cradle around his neck, the horse is j)i'evented from carrying his 
head on either side ; its use, however, must be carefully watched 
lest the friction of the cord, which secures it in place upon the 
superior border of the neck, should cause severe complications by 
chafing or even cutting through the skin. Peuch and Toussaint 
have reported one case of fatal tetanus from this cause, but no 
such accident ought ever to occur, for the means by which it may 
be avoided are easy and obvious, protecting the border of the 
neck with pads. The side bar prevents the flexure of the neck 
toward the side upon which it is placed, and when in use during 
an operation is applied on the side occupied by the operator. 
It is used both singly (on one side only), and doubly (on both 
sides). 

The danger of accidents arising from the iinrestrained mobiHty 
of the head of the animal being thus guarded against, those which 
may be caused by striking and kicking with the feet are next to 
be considered. In many instances it may be sufficient to simply 
raise the foot from the ground, and to keep it thus suspended by 
holding the leg in a position of flexure (Fig. 6). 

No violent measures are necessary in order to obtain such con- 
trol over the movements of the horse as are consequent upon com- 
pelhng him to support his weight on three legs only. The method 
of raising the foot and keeping it off the ground is a matter too 
familiar to every stable hand to need detailed instructions. But 
a little art may be necessary, with a little compulsion added, to 
induce him to contiaue to sustain the role of a tripod long enough 
for the purpose of the operator. But this cannot always be de- 
pended on, and therefore when he betrays an evident unwilling- 
ness to submit quietly to such a confinement of the foot, the com- 
pulsion of the ropes or straps must be resorted to. For the fore 
leg the strap is attached below the fetlock and passed around the 
forearm, and either buckled or held in place by an assistant. 
When the rope is used it is passed around the coronet, the leg 
flexed and the rope either passed round the forearm and secured 
in the same manner as the strap, or thrown over the withers and 
held by an assistant on the opposite side of the horse. For the 
hind legs the rope, plaited rope or plate-longe, is necessary with 
the hobble. These are applied in different ways. 



SECURING SOLIPEDS. 



21 




Fig. 7a.— Plaited Rope. 



In tlie Jirst method a hobble is placed on the coronet of the 
foot to be raised, with the buckle outward, and the ring looking 
backward; then a loop made at the flat end of the plate-longe is 




Fig. 8.— Securing the Hind Foot with Rope and Hobble. 

passed around the neck ; the rope is then carried along the back, 
and with a single turn around the tail, is passed through the ring 
of the hobble, from within outward. Pulling on the rope raises 
the foot and carries it backward, where it is held by the assistant. 

Second. — Sometimes the hobble is dispensed with, and the 
rope is passed from the neck straight to the coronet, where a 
double twist is made, and the foot controlled as before (Fig. 9). 

Third. — In other cases, the plate longe is secured to the tail, 
instead of around the neck, conditioned of course upon whether 
the tail is sufficiently long and furnished with hair of the strength 



22 



MEANS OF BESTRAINT. 




Fig. 9.— Securing one Hind Leg with Rope only. 

necessary. Wlien matters are favorable in tliis respect, the 
operator proceeds as follows : a loop being made at some distance 
from one end of the rope, it is laid flat on the top of the tail, close 
to its origin, and the short end being twisted aroimd that extrem- 




FiG. 10.— A, The Twitch. B, Side Bars. C, Surcingle. D, Securing Hind Foot. 
E, Fixing the Eopo on the TaiL 



SECURING SOLIPEDS, 



23 



ity with from two to four turns, and the remaining portion passed 
through the loop, and the other, or longer portion of the rope, 
drawn taut, the knot is tied and the plate-longe thus firmly 
secured. As in the two previous methods, by drawing upon the 
longer end of the rope the foot can readily be raised and held in 
position, either with or without the hobble. 

There are occasions, when, although it may not be required 
to have the leg and foot held up for the purposes of the opera- 
tion, it still becomes necessary to do so in order to prevent the 
animal from using his feet as weapons of combat, or to restrain 
him from motion. 

The plate-longe, and the single or double side-line, with one 
or two hobbles, are then put in use, for the purpose of either 
raising the leg from the groimd and compelling the animal to 
stand on three, or again to prevent motion ia the posterior biped. 
For example, in one case the flat part of the plate-longe is 




Fig. 11. — Another Means of Using the Rope. 

passed with a loop around the coronet of the leg to be kept steady, 
the rope is then carried forward between the fore legs, then on 
the side of the neck opposite to that of the leg to which the 
plate-longe is fixed, over the withers, back to that side, and twisted 
around itself behind the elbows, as it passes between the fore 
legs (Fig. 11). 



24 



MEANS OF BESTEAINT. 



In other cases a large loop of the plate-longe is thrown over 
the neck, and the rope carried back to the coronet of the foot to 




Fig. 13.— Securing both Hind Legs witb Hobbles. 



SECTJKING SOLIPEDS. 25 

be secured, and by one or two twists around itself, is brought 
backward, where it is held by an assistant. Sometimes a single 
hobble is placed on the coronet, and the rope of this side-Hne 
runs through its eye, which is turned forward (Fig. 12). 

To prevent the animal from kickiag with both hind legs, a 
King hobble, carrying the chain, is put on one leg, and the chain 
passed through the eye of another hobble placed on the other 
hind leg, and the rope carried forward and secured as in the case 
of raising one single foot, viz., between the fore legs, on either 
side of the neck, over the withers and then after being twisted 
around itself back of the elbow, held by an assistant (Fig. 19). In 
some instances a double side-line is used, the loop being thrown 
over the neck, and the ropes carried backward, one towards each hind 
leg, and passed through the eyes of hobbles placed on them, and 
returned forward, where they are secured with a slijD-knot to the 
loop of the side-line on each side of the neck. 

For the same purpose, of securing the two legs of a biped, 
whether anterior or posterior, LeGoff has invented a pectdiar 
apjDaratus, consisting of a Y-shaped rope, single at one end and 
bifurcated at the other, each of the three ends having a running 
noose or loop. If the two hind legs are to be secured the loops of 
the bifurcated portion are placed on the coronets of these legs, 
and the loop of the single portion secured on one of the fore 
legs. If on the contrary, the fore legs are to be confined, the 
arrangement is simply reversed. 

Another excellent method of limiting the movements of the 
animal to prevent him from kicking, and keep him quiet, is to take 
a plate-longe, and beginning on one of his sides, at the girth, for 
example, pass it forward across one forearm, a Httle below the 
elbow, in front of him, on the other side across the other fore- 
arm ; then backward across the thigh, or a little below it, then 
passing it back of the animal, to the first side across the other 
thigh, to return to the starting point (Fig, 14). Passing the rope 
through the eye of the flat extremity of the plate-longe, the legs can 
be comparatively well kept together. To prevent the rope from 
dropping too low, it is thrown over the back and secured on 
itself on the other side by a knot. This part of the rope over the 
back supports the two horizontal portions which rim. on each side 
of the animal and keeps them in place. 

This mode of restraint is but a simplification of the apparatus 



26 



MEANS OF EESTKAINT. 




Fig. 14.— Securing all the Legs, with Rope all around the Animal. 



invented by Raabe and Lunel — the hippo-lasso (Fig. 15). This 
apparatus is called the straight jacket for horses, by the inventors, 
and is composed of a strong breast-piece or Dutch collar, and a 
breeching, placed over the withers and the croup. The breeching 
carries on each side, firmly sewn on, a long strap, and at each 
point, B, an iron eyelet. The breast-piece at B, carries also on 
each side an iron eyelet, and on the front strap a strong buckle. 
To place it in position, the Dutch collar is thrown over the neck 
and the breeching laid over his rump. Both straps of this part of 
the hippo-lasso are passed forward through the iron eyelet of the 
breast-piece at B, back through that of the breechiag at B, and 
then forward again to be buckled, more or less tightly, at h. The 
length of the strap of the Dutch collar piece which passes over the 
neck, and that of the croup, must be regulated in such a manner 
that the horizontal position of the lasso is for the fore legs, but 
a little below the forearm, and between the stifle and the hock 
for the hind legs. 

The hippo-lasso is an excellent means of restraint, and may 
even be utilized for vicious animals upon which operations would 
otherwise be impossible, except by throwing them. In shoeing 



SECUBING SOLIPEDS. 



27 




Fia. 15.— Hippo-lasBo of Raabe & Lunel. 

vicious and clijDping nervous horses it has given most excellent 
results. 

Among other varieties of apparatus used for controlling 
animals in the standing position, are the various machines known 
as stocks or travis. They are of many forms, and consist of heavy 
wooden frames, firmly secured ia the ground, with peculiar arrange- 
ments for supporting the animal in shngs, if necessary. They 
are padded on the inside, for security against injuries and have on 
one of their narrow sides a system of iron bars, against which to 
secure the feet when the animal is raised from the ground. The 
stock illustrated ia Peuch and Toussaint's work (Fig. 16), will 
give a good general idea of one of the most approved forms of this 
means of restraint. The stock of E. Winsot (Figs. 17, 17a and 
18) is another form, which can be used for securing the animal iu 
either standing or laying position. 



BECTJMBENT POSITION. 

Notwithstanding the many advantages attending the applica- 
tion of the means already described, devised for securing the 
immobility in the standing position of animals undergoing sur- 
gical treatment, there are circumstances in which their efficiency 
becomes wholly lacking. Sometimes it is because of the invincible 
restiveness of the animal, but more often because of the serious 
nature of the pending operation, which may require for its safe 



MEANS OF KESTEAINT. 




Fig. 16— The Stock. 



performance a degree of deliberation and an amount of dissection 
of the most painful character, with which only the most absolute 
passivity, if not complete unconsciousness, is compatible. In this 
class of cases the recumbent position in the patient becomes sim- 
ply an indispensable requirement. 

To throve or cast a horse signifies simply to apply the force 
necessary to compel or induce him to lie down, and to continue 
in that position during the pleasure of the surgeon. The forms 
of compulsion by which the desired result is to be effected are 
next to be considered. 

It would be improper to construe the word "throwing" as 



SECURING SOLIPEDS. 



29 




Fig. 17a.— Firing a Horse while Secured in Winsot's Stock. 




Fig. 18.— Laying a Horse Down with Winsot's Stock. 



30 MEANS OF RESTRAINT. 

literally designating tlie act of violently casting down, as in a 
wrestling match. On the contrary, it must be quahfied as refer- 
ring to a method of so manipulating the patient and directing his 
movements as to briag about a change of postvire with all the 
appearances of a voluntary act on his part, which indeed it essen- 
tially becomes. 

The prejDaration of the bed upon which the animal is thrown, 
and of its location, will require some judicious attention from the 
surgeon. A convenient place, with sufficient space to allow per- 
fect freedom of movement about the patient, such as a large yard, 
a barn or an open field will fulfil the requirements. The ground 
should be smooth, and, if possible, soft — a pasture lot or farm- 
yard, or a manure heap often offering good facihties for the pur- 
pose in country practice. In any case it should always be covered 
with a layer of straw, sawdust or tan bark of sufficient thickness 
to prevent a violent concussion when the patient falls, and ought 
to be sufficiently wide to allow him to fall as nearly in its center 
as possible. Its dimensions should be approximately from nine 
to ten feet square. 

An important point ia its construction is that it should be free 
from any hard foreign substances, such as stones, bones, pieces 
of wood or iron, etc., for fear of contusions or other similar lesions 
against any parts of the body of the patient. 

Several methods are in use for throwing a horse, among which 
are the peculiar apparatuses known as the hobbles. The rope.s 
and the operating tables are also used. The previous preparation 
of the animal for the operation ought not to be forgotten. This 
usually consists in a fast of not less than twelve hours, and will 
always be found to be a good measure. 

A. — Casting with Hobbles. 

These are of various kinds. Some are made of leather, others 
of rope, but they are all constructed upon the same principle. The 
English style, invented by Bracy Clark and afterwards improved, 
which are in most general use, present so many advantages in their 
facility both of application and removal from the legs after the op- 
eration, that we shall limit our consideration to them alone (Fig. 19). 

A set is composed of four hobbles, a chain and a spring hook. 
Each hobble is formed of two straps of leather of unequal length, 
the shortest (a) having attached on one end a strong buckle (^), 



SECURING S0LIPED8. 



31 




Fig. 19— English Hotobles. A, Hobble Unbuckled. B, King Hobble. C, Hobble In 
Position, witli Kope through the Eye. 



and at the other an iron eyelet, narrow and somewhat elongated 
(n), the eyelet of the longest {b) being somewhat square in form (e), 
in order to allow the ring (n) to pass through it, and having in its 




Fig. 19a.— Self-locking Hobbles of Prof. Barker. 



32 



MEANS or EESTKAINT. 



length a number of holes to aUow it to be buckled with the short 
strap. Three of each set are of this construction. The fourth, 
which is the main, chief or king hobble, differs from the others 
in the form of the iron eyelet of the shortest strap. In this hob- 
ble it is made of a peculiar shape, and with a small slot, 
through which the chain is passed and secured by a pin-screw 
running through it. The chain belonging to this set measures 
four or five feet in length, and has spliced at one end a casting 
rope some fifteen feet long. At the other end the link of the 
chain is flattened and made to slip easily through the slot of the 
main hobble. 






Fig. 20.— Spring and String-Hooks. 

There are many forms of spring-hooks used. In our own 
practice we use two strong spring padlocks, as being of easier 
appHcation and less liable to liberate the animal by becoming 
loosened or breaking. 

Besides the set of hobbles, a long plate-longe and a Bernardot 
& Buttel apparatus are necessary. This consists of a wide and 
strong svircingle, having on both sides two straps, joined together 
in front, and a strong halter, which from the nose-band carries 
another strap, which passes in front of the head, between the ears, 
through an iron ring on the pole-band of the halter, and is to be 
buckled to the single strap of the surcingle. By shortening this 
strap, the head and neck are placed and kejpt in as much exten- 
sion as may be desired. 

Prehminaries being completed and instruments ascertained to 
be in efficient condition, the horse is placed at the side of the bed ; 
and we may here repeat that the manipulations which are next to 
succeed are not designed to throw him off his feet with a violent 



SECURING SOLIPEDS. 



33 




Fig. 21.— Bemardot & Buttel Apparatus. 



shock, but simply to place him in a posture of such discomfort, 
and so to disturb the center of gravity that lying down becomes 
an instinctive act, and is done voluntarily, in order to avoid the 
act of falling ; it may be termed a voluntary compulsion. 

When brought to the bed, a cap is placed over his head, and 
aU the hobbles are applied, simultaneously if possible, by four 
assistants acting in concert. They should carefully observe that 
the large buckle of each hobble is placed on the outside of the 
leg, and that the eyes of the straps are turned toward the center 
of gravity of the animal, those of the front hobbles looking back- 
ward, and those of the hinder hobbles looking forward. The 
chief hobble must be placed on the fore or hind leg of the side 
opposite to that on which the animal is to lie. 

The apj)Hcation of the hobbles on a timid and restive horse is 
not always an easy matter. Remembering, perhaj)s, some similar 
experience at some former period, he rebels, resists and kicks as 
a natural consequence. If speaking soothingly and kindly, and 
employing the usual tranquihzing and assuring processes, with 
the raising of one of the fore feet, fails to quiet and control him, 
a twitch is placed on his nose and left on untU, at a preconcerted 
moment, the hobbles are put in place; quickly, but as noiselessly 
as possible, the chain is passed through the ring of the chief hob- 
ble — on, say the fore leg for facility of description — then through 
the ring of the other fore leg, back to the ring of the hind leg of 



34 



MEAKS OF EESTEAINT. 



the same side, through the ring of the other hind leg, and back 
to the slot of the main hobble, where it is secured by the pin- 
Bcrew. The Bernardot & Buttel apparatus is then put in place 
and buckled by an assistant, with the surcingle on the side of the 
patient ojyposite to that on which he is to be made to he. Previ- 
ous to this, another assistant will have passed a long rope around 
the body of the animal a httle back of the withers, and with still 
another holds it on what will be the under side when the patient 
lies down. Still another assistant is placed at his head, to aid the 
one who holds it, while yet another grasps the tail, and two others 
seize the casting rope. 

The second step of the operation is to reduce the animal's 
base of support as much as possible, by bringing the four feet 
together. To do this, the operator, standing in front of the as- 
sistants who hold the casting rope, has each hind leg in succession 
raised sHghtly from the ground and carried forward by the assist- 
ant having it in charge, a gentle traction being made at the same 
time upon the casting rope, in order to shorten the length of the 
chain passing through the hobbles, the assistants at the head 
meanwhile gently backing the animal still more to reduce his area 
of support, until the equilibrium is so nearly lost that the animal 




Fig. 22.— Horse about to be Cast. 



SECURING S0LIPED8. 35 

instinctively abandons the effort to keep his feet, and assumes the 
recumbent posture in order to avoid the shock of a heavy fall. 

H. Bouley recommends that the first movement in this final 
step should be an attempt to back the horse, in order to move the 
fore legs first, and then to bring the hind legs forward, if the base 
of support is still too broad. The twitch should now be removed ; 
in fact, the most prudent plan would be to remove it the moment 
the hobbles are in place 

The final step of the act of literal throwing or casting being 
accompHshed, the last indication remaining to be fulfilled is to 
seciu-e the patient in the most favorable position for the surgeon 
to perform the important work of which aU that has been under- 
taken has been but preliminary. It is properly the permanent 
(for the time being) adjustment of the body in such a manner as 
to allow the surgeon the best possible access for all his manipula- 
tions to the region which is to be the seat of his dissections 
and other operative movements, without any unsteadiness or 
opposition. 

Bouley's dii*ections for this purpose are that the operator, 
watching for the right moment, as the horse begins to totter, 
gives orders to the assistants having charge of the ropes acting 
on the body, the tail and the head, by a prompt and simultaneous 
action, to pull in the dii-ection of the side on which the animal is 
to he, and to those at the casting rope to pull firmly but not 
harshly in the opposite direction, while he himself pushes the 
body of the animal towards the bed. By this arrangement of 
opposing tractions the casting is easily efi"ected ; but luiless the 
assistants act in perfect concert, and especially if the casting rope 
be drawn too rapidly and suddenly, the animal will be raised from 
the ground with a sudden lift, to fall so heavily on the bed as to 
possibly subject him to the risk of sustaining severe injuries. 

Bouley remarks on this point: "An animal is properly cast 
only when, bending his knees, he Hes down softly and easily on 
his side, bringing to the ground successively the shoulder, the 
ribs and the hind quarters; or again when, the fall beginning 
from behind, the order is exactly reversed." 

Once down, the forcible traction upon the chain brings the 
four legs in close proximity, the spiing hooks or padlock passing 
through the link nearest to the ring of the hobble through which 
the chain passes, coming out last. To provide against the possi- 



36 



MEANS OF KESTKAINT. 



ble breaking of that portion of the chain which embraces the four 
hobbles, Peuch & Toussaint advise the passing of the casting rope 
and chain a second time through the rings of every hobble before 
it is secured with the spriag hooks. The animal being down, the 
straps of the Bernardot & Buttel apparatus are buckled, and the 
head well extended on the neck. The use of this apparatus con- 
siderably diminishes the difficulties involved in the contention of 
the head. Before its iatroduction, two assistants were required 
to keep it in extension and comparatively motionless ; and even 
then the results were not always easily reached nor accidents 
avoided, whereas, with this halter and surcingle arrangement a 
single strong assistant is sufficient to secure control of the head; 




FlO. 33 —Horse Thrown and Secured by Bernardot & Buttel Apparatus. 



SECURING SOLIPEDS. 



37 



and it has the advantage, besides, of " preventing fractures of the 
vertebral column, rupture of the diaphragm, and rupture of in- 
ternal viscera." 

In some exceptional cases the surgeon will be obliged to im- 
provise his hobbles. This may be done by fastening four ropes 
of suitable length around the coronets, allowing sufficient room 
for the passage of the casting rope between the hobbles and the 
skin, or again placing an iron ring through these loops of rope, 
which are secured by a knot on the outside of the leg, as suggest- 
ed by Mr. Dneubourg. 

The removal of the hobbles and of the other apparatus em- 
ployed in casting the animal, demands similar care and attention 
to that which was required to put them on. While the Bernardot 
& Buttel surcingle is unbuckled, the assistant loosening the 




Fig. 24.— Improved Hobbles of Dneubourg. 

straps of the cap, and ready to remove it at a moment's notice, 
the operator placing himself facing the soles of the feet, in order 
to be out of danger, cautiously unscrews the screw-jpin which 
fastens the chain to the principal hobble, and removes it, when all 
the hobbles becoming loose, are removed, and the animal being 
freed from all restraint, is allowed to rise. 

While the animal is rising it will be but prudent in the by- 
standers to allow him all the scope he may choose. The action is 
sudden and somewhat violent, and he may move his liind legs 



38 MEANS OF KESTEAINT. 

with a sudden jerk which may throw the hobbles off with force suf- 
ficient to severely hurt some unguarded spectator upon whose per- 
son they might infringe. We have been witness to such an oc- 
currence, when they were thrown a distance of twenty feet, with 
violence sufficient to inflict, possibly, dangerous injuries. 

An animal thrown and secured as has been described is in a 
suitable position for the majority of operations, such as those 
about the head and neck, of the body, or of the upper part of the 
legs. But in many cases, it is necessary to fix a leg in a peculiar 
position either to expose a given region of the body, or when 
the limb itself becomes the seat of operation. The action of se- 
curing the animal in the recumbent position is one of great im- 
portance, and none of its details ought to be overlooked. And 
there are several points to which we have already referred in our 
introduction, which may be again noticed with advantage. Bear- 
ing in mind the accidents which may result from keeping the 
horse in a state of painful passivity, and his instinctive struggles 
to free himself, not to mention the painfulness of the constrained 
posture itself, the inference is palpable that it is incumbent on the 
surgeon to release the suffering patient from his trying constraint 
at the earliest moment consistent with the proper comjDletion of 
the operation. Again, in securing the legs, care must also be 
taken that, although a given position of a leg may facilitate the 
movements of the operator, it is not justifiable if there is another 
mode of securing the same object by means more comfortable 
and less dangerous to the patient, as well as easier for the surgeon. 

An experience of many years has taught us that six principal 
modes of fixing an animal's leg, fulfil all necessary requirements, 
and that the special purposes and effects of these are such as to 
forbid their modification. 

In considering these six specific modes, it will promote facility 
of description if the reader will follow our references to the dif- 
ferent legs on a sort of mental diagram which by a mode of ab- 
breviation by initials will designate — supposing the animal to be 
thrown on the near side — the near anterior as N.A.; the off 
anterior as O.A.; the near hind as N.H.; and the off hind as O.H. 

First position — Exposing the inside of the JV.A. leg. — A loop 
of the plate-longe is secured on one of the fore legs, above the 
knee, say the off leg, carried in front of the near leg, under it, 
back and between the fore legs, always above the knee, to return 



SECUKING SOLIPEDS. 



39 




Fig. 25.— 1st Position. Neurotomy. 

to the starting point, around the off leg again, back to and be- 
tween the legs, thus forming a complete figure 8. This is re- 
peated twice or three times, when a turn around all the crossings 
of the rope between the legs ties up all the twists of the rope and 
a double slip-knot is made on the forearm of the off fore leg. 
Both legs thus secured, the near leg is released from the hobble, 
and carried forward by an assistant pulling on it with a rope tied 
around the foot. 

For reasons already stated, we consider this position as the 
only one justifiable for neurotomy on the inside of the off leg, or 
for tenotomy. Firing on the inside of the coronet for ringbone, 
or along the tendons, might also be performed in this position. 

Second position — Securing the off fore on the off hind leg. — The 
loop of the plate-longe is placed on the O.A. leg about the middle 




Pig. 26.-2(1 Position. Ist Step. 



40 



MEANS OF EESTEAINT. 



of the cannon region, from there carried backwards over the O.H. 
leg, above the hock, between both hind legs, and forward, be- 
tween the fore legs and reflected back over the forearm, about 
its middle, when it is given to an assistant stationed at the back 
of the animal. An assistant is placed ia front of the animal, 
kneeling on the bed, and prevents the rope which passes ia front 
and over the forearm from sHppiag down too rapidly. The leg 
being released from the hobble, the operator holding it carries it 
backward, while the assistant at the back puUs slotoly but 
steadily on the rope, the action of this lever of the first kind, 
with its fulcrum on the O.H. leg, the resisting power at the foot 
of the animal and the moving power at the forearm of the off, 
moves and draws the leg backward until it reaches the cannon 
bone of the hind leg. At that moment, steadily holding every- 
thing in place, the rope that is passing above the hock on the 
near hind leg is allowed, cautiously, to sHp below the hock, and 
the near fore leg is then brought to the middle of the near hind 
cannon bone, where it is secured with a double figure 8. Other sur- 
geons secure the fore leg above the hock as in the plate we borrow 
from Peuch and Toussaint (Fig. 27). The danger of injury to 
the tendo- Achilles has caused us to change that position to the one 




Fig. 27.— 2d Position. 2cl Step. 



SECUEING SOLIPEDS. 



41 



above described. In this position the inside of the N.A. leg is ex- 
posed, and it can be fired, either for disease of the knee or of the 
tendons and bursse. All operations upon the foot of the O.A. can 
be performed except those required on the inside of that foot, 
such as those for inside quarter-crack, complicated suppurating 
com or inside cartilaginous quittor. 




Fig. 28.— 3d Position. Securing Upper Hind to Upper Fore Leg. 

Third position. — Securing the off Jiind uponthe corresponding 
fore leg. — In this the rope is first secured in the middle of the off 
hind cannon region, carried forward and over the forearm, above 
the knee, in front of the forearm, back between the fore legs, 
between the hind legs and over the near hind leg, above the 
hock, to the assistant stationed at the back of the animal. Ke- 
mo"\ing the leg from the hobble, and pulling on the rope the 
near hind leg is brought, by the same method, to the middle of 
the off fore cannon, where it is secured with a figure eight twist of 
the rope. In this operation the inside of the near hind leg is ex- 
posed from the hock down, and in that position, operations on the 
inside of the hock can be performed, such as firing for spavin, 
thorough-pins, ciu'bs, and cunean tenotomy, as well as firing on 
the inside of the tendons, or even tenotomy. As far as the off 
hind leg is concerned, only operations on the foot are justified, 
with the exception of those on the inside of that part of the leg. 

Fourth jyosition — Securing the near fore on the off hind leg. — 
The rope is secured by a loop on the middle of the cannon of the 
near fore leg, which rests directly on the bed, carried backward 
over the off hind leg above the hock, back between the hind legs, 



42 



MEANS OF RESTBAINT. 




Fig. 29.— 4th Position. Securing Under Fore on Upper Hind Leg. 

forward under the forearm of the near fore leg, between the 
fore legs and back to the assistant at the back of the animal. In 
this action it again becomes a lever of the first kind, with the 
fulcrums above the hock, the resistance at the lower part of the 
near fore leg and the moving power at the forearm. The leg is 
drawn from its deep position to a superficial one, and secured 
with a figure eight on the middle of the near hind cannon, and 
not above the hock, for reasons already considered. This posi- 
tion is only justifiable for operations on the inside of the near 
fore foot, such as complicated quarter-crack, complicated suppu- 
rative corns, inside cartilaginous quittor, and the like. The pe- 
ciiliar awkwardness of this position, in which the leg is carried 
in excessive adduction subjects the animal to the danger of severe 




Fig. 30.— 5th Position. Securing Under Hind on Upper Fore Leg. 



SECURING SOLIPEDS. 



43 



lesions in the axillary region, and it is justifiable only in the cases 
specified. 

Fifth position — Securing the near hind on the cannon of the 
off fore leg. — The rope is first tied up by a loop on the middle of 
the near hind cannon bone, forward over the forearm of the off 
fore leg, between the fox'e legs, and back to under the near hind 
leg, between the hind legs and to the back of the animal, where it is 
held by an assistant. The leg is again drawn from under him, is 
steadily brovight to below the knee of the off forearm and secvu'ed 
as in the other positions. In this position the only operations 
to be performed are those on the inside of the digital region, or 
rather of the foot of that leg. 




Fig. 31.— 6th Position. 



Sixth jyosition — Securing the off hind leg near the neck or 
shoxdder of that side of the body. — The rope is tied ujj by a loop 
around the coronet of the off hind leg, that is below the fetlock, 
carried forward toward the superior border of the neck, under 
the neck and then toward the inferior border of that region, back 
over the whole length of the animal to the front of the hind legs, 
between these and over the tibial region of the off" hind leg, where 
an assistant holds it to the back. Other assistants, pulling on 
the rope, and making it slide as it passes on the borders of the neck, 



44 



MEANS OF RESTEAINT. 



the operator carries the leg forward until it reaches the outside sur- 
face of the shjoulder, or the lateral j^arts of the neck, where the rope 
is secured by a double twist and knot around the coronet of the 
near hind leg displaced. This awkward and painful position is 
for operations in the inguinal region, including castration, in- 
guinal hernia, removal of champignon, amputation of the penis, 
or removal of tumors. 

When the operations which have necessitated these various 
positions have been completed, the leg which has been restrained 
should be returned into its proper hobble, and this should be 
done slowly and carefully, avoiding any unnecessary motions or 
noises, and the animal relieved of his means of restraint as in all 
other operations. 




Fig. 32.— Side Bar Hobbles. 

In a few instances, however, aside from these various 
modes of securing individuals, the surgeon has recourse to 
the side bar hobbles, which carries a hobble of its own at each 
end, one hobble being fixed on a fore, the other on a hind leg. 
Some of the English veterinarians are using the o'oss hobbles, 




Fig. 33.— Cross Hobbles. 

which has the advantage of being adapted for use upon legs 
diametrically opposite, such as the near fore and the ojff hind legs, 
and vice versa. 

jB. — Casting with ropes. 

The hobbles are not the only kind of apparatus devised 
for throwing horses, nor are they all made according to the 
English pattern, although the same general principles pre- 
vail in all. Ropes in the form of side lines, either single or 



SECURING SOLIPEDS. 



45 



double, are often substituted for hobbles, and for many varieties of 
these special claims are made by their inventors, or by those who give 
them their preference, and use them in then- practice. Without 
entering into the consideration of the comparative merits of these 
various methods, which vary, not only in nearly every country of 
the world, but even in different sections of the same country, 
there is a mode of their appHcation, upon which we have a word 
of comment to offer. This is the mode with a single, and that 
with a double rope. 

(1st.) With a single rope. — This is the simplest mode of 
casting, but it is also the least safe. It is the oldest of the 
methods in use, but has in our days been more or less modified 
and improved. The method of Rohard seems to be as perfect as 
any of them. In this, a rope from twenty to twenty-five feet in 
length is necessary. The horse being placed near the bed where 
he is to be thrown, is held in the ordinary manner. If he is to lie 
on the near side, the operator is placed on the right, near the 
shoulder with the rope, in which is a knot about six feet from its 
end, which Rohard calls the ring knot («), and immediately below 
it is another, called the stop2nng knot {h), through which the rope 
will run. "In this way," says Rohard, "there is a large loop 




FlQ. 34.— Application of tUe Rohard Method. 



46 



MEANS OF KESTKAINT. 



formed, which is thrown over the neck, while both knots made 
lie a little below the point of the shoulder." Taking with the free 
portion of the rope, a twist round both forearms, passing behind 
them first, then forward across the near fore leg, in front of both 
fore legs, and backward across the off fore leg, over the rope, it 
is carried across the abdomen, to the near hind coronet, which it 
surrounds from without inwards, to be brought back to the 
posterior part of the withers on the near side, where the operator 
takes hold of it. Then by degree^ slowly pulling on the rope, 
and making the animal raise his near hind leg by quietly urging 
him, this leg is carried forward, with a uniform movement, until 
at one. moment, the animal attempting to resist or struggle, 
the assistant at the head carries it toward the bed, the operator 
pressing with his body against that of the animal, until he slowly 
settles down without injury on his side. To fix the leg definitely, 




Fig, 35.— Animal Secured by the Rohard Method. 

one begins by the near hind leg. Making a double twist of the 
rope around the coronet of that leg, this is carried towards the 
loop which passes around the neck, and is there secured by a 
double knot (a), and carried back to the off hind leg, which is then 
carried far forward and secured to the same collar loop, with a 
single knot (/>). To release the animal, it is merely necessary to 
untie the stopping knot, when the rope becomes loosened from 
the legs. 



SECUEING SOLIPEDS. 47 

(2d. ) With double side lines, or ttco ropes. — This is done by means 
of a long rope, doubled in its middle, and having a knot made in 
such a way as to form a loop large enough to be drawn over the 
head and neck of the animal ; the two ends below the knot are 
then passed in front of the chest and between the fore legs, 
carried, one to each hind leg, around the coronet, turning it once 
around the main rope, and passed on the coUar loop from within 
outwards, to strong assistants standing on each side of the 
animal. By steady pulling both hind legs are carried forward, 
until the animal loses his balance and settles on his haunches, 
when a strong effort of the assistant at the head brings him down 
on the bed. The hind legs are secured to the collar loop with 
the ends of the rope, and the fore to the hind legs in the same 
manner. 

The various methods of casting which we have been consider- 
ing, with hobbles and with ropes are, as we have before said, not 
the only plans recommended. Almost every country * f Europe, 
while also using the hobbles, has a fashion of its own in which the 
ropes are utilized, and as to the fact of their widespread, if not 
universal use, it would seem that not a few veterinarians of exten- 
sive practice have originated and employed special methods of 
their own devising, for which they claim more or less superiority. 
Among those recommended in this coimtr}^ we may mention the 
apparatus of Mr. Miles, which he has used for years in his exten- 
sive practice as castrator. Dr. Wm. Dougherty, of Baltimore, has 
sent us a set of rope-hobbles and side-line, which upon personally 
testing we are able to recommend as possessing important points 
of excellence, especially in casting young colts for castration. For 
further light and broader information on this subject we must 
refer our readers to the standard authors by whom it has been 
discussed in the French, German, Danish and Russian tongues, 
feeling at the same time quite confident that the general rules 
which we have suggested and illustrated for the performance of 
the operation of casting are sufficient to guide any inteUigent 
operator through all the steps of the proceedings. 

C. — Casting on the Operating Table. 

The necessity of employing such a number of assistants in 
throwing a horse, with the difficulties often encountered in con- 
ducting all the steps of the operation, and the accidents which 



48 



MEANS OF KESTKAINT. 



too often accompany its execution, have led to the invention of 
other means of accomplishing the object in which the objections 
to the old method are sought to be obviated. It was with this view 
that the operating-beds of Lafosse in France and Hart in Wurtem- 




FiG. 36.— Wall-bed of Fromage de Feugre 

burg were contrived. The wall-bed of Fromage de Feugre pos- 
sessed many advantages, but was abandoned on account of its 
compHcated structure. Of late years, however, several other 
forms of operating tables have been devised, of which one espe- 
cially is highly commended by European authors. It is that of Mr. 
J. Daviau which consists of a broad and heavy table, furnished with 
pads, surcingles, hobbles, ropes and other necessary appurten- 
ances for securing the animal, and which is moved by a pecuhar 
crank arrangement which permits its adjustment in any required 
position, from the horizontal to the vertical, and by which it may 
be turned down flat upon an iron frame. The apparatus is placed 
solidly on the ground, or can be made movable by a set of low 
wheels attached to the heavy wooden frame upon which the table 
and the crank are supported. 

Mr. Daviau claims for his invention: 1st. That it obviates "all 
the complications " accompanying the ordinary system of throw- 
ing. 2d. It allows " the easy and comfortable rising of the horse " 
after the operation, without danger. 3d. It gives entire security 
to the operator, who can perform his task alone and without the 



SECUKING SOLIPEDS. 



49 




60 



MEANS OF RESTRAINT. 




SECURING SOLIPEDa 



51 




52 



MEANS OF EESTEAINT. 




Fig. 40.— Hodgson & Magee'e Table. Back View ; showing the working of pulley to 
draw the table down. 




SECURING SOLIPEDS. 53 

need of assistant. 4th. No assistants are needed to be exposed 
to dangei', and the responsibility of the operator is diminished. 
5th. Economy of time. 6th. Economy of material and space for 
the performance of the ordinary operation of casting. 

In this country several forms of tables are in use. Those of 
Dr. Tiffany, Price and others, all of which are constructed somewhat 
upon the same principles with respect to the action of an iron 
crank to control the position of the table. Doctors Hodgson & 
Magee, both veterinarians of New York, have invented a table which 
for simplicity seems to surpass any one we have yet seen (Fig. 40). 
Like the others, it has slings, ropes, hobbles, pads, etc., but dif- 
fers from them in two important particulars. The first is the 
manner in which the table is lowered and raised ; the second, the 
manner in which the hobbles are secured and made immovable. 
In the middle of the superior border of the table, and directly 
below it on the posterior face, are two solid iron rings. In the 
ceiling of the operating room, or on the cross-piece of the frame 
in which it is enclosed, and dii*ectly opposite that in the border of 
the table there is another. Another is fixed in the floor some dis- 
tance back of the frame upon which the table rests when in a 
horizontal position. To these rings two systems of pulleys are 
attached, one connecting that in the ceiling with that in the bor- 
der of the table ; the other connecting the ring on the posterior 
face of the table with that in the floor. Besides this, under the 
table are two strong iron eyelets through which chains are passed, 
which at one end are secured to the hobbles by openings through 
the table, and at the other are secured from slipping through the 
ring by a wide T arrangement, secui'ed on the last link. These 
chains measure the distance which exists between the rings on the 
floor and the table when in a horizontal position. 

When the horse is brought alongside the table and tied up 
with the slings, the halters and head-straps securing him, and the 
hobbles being in place, the rope of the upper pulley is pvdled by 
an assistant, and the table moved slowly into the proper position. 
The rope being then fastened to the ring in the floor, the table is 
immovable. Upon the completion of the operation the rope is 
gradually slackened, while an assistant pulls on the rope of the 
base of the table which is thus restored to the vertical position. 



64 



MEANS OF BESTKAINT. 



MEANS OF SECUKING OTHER DOI^IESTIC ANIMALS. 

{a) BoviNES. — With these animals benignant measures are of 
Httle avail. Kindness may in some possible cases — but they will 
be rarely met with — succeed to a limited extent, but to trust to 
the influence of the treatment so often effective with an inteUigent 
and docile equiue, such as the petting caress, the soothing tone 
of voice, or the kindly glance of a human eye, with even the placid 
and mild-eyed milch kine, will be only an act of misplaced con- 
fidence. To blind them, to induce dizziness by turning them 
rapidly in a small circle, may at times produce good results, but 
even then these measures will be more reliable if combined with 
more palpable agents of restraint. 

Cattle may be kept quiet in the standing position by raising 
their heads, by passing the index finger and thumb of one hand 
into the nostrils, with the arm over the face, and raising the tip 
of the head upward, while the other hand, grasping one of the 
horns, moves the top of the head downward, the resistance of the 
animal being overcome by pinching the nose with the hand which 
grasps it with more or less force. By this means the head of the 
animal is fixed, and the operator guarded against injury from the 
horns, and the movements more or less Hmited. While maintain- 
ing this position, the cavity of the mouth can be examined and 
even short and simple operations rapidly performed. Another 
device for preventing the animal from using his horns as a means 




Fig. 41.— Securing Cattle. 



SECTJKING OTHER DOMESTIC ANIMALS. 



55 



of contention is to tie a long rope around their base, passing it 
along the neck and the back with one loop around the ribs and 
another further back around the flanks, and when reaching the 
tail securing it there by a knot at the base of that member. The 
head is thus kept elevated, and he is restrained from motion by 
the pain experienced by the tail when the rope is tightened by his 
attempt to flex it. This assiu'es his passiveness (Fig. 42). 

The practice of shielding the sharp points of the horns with 
smooth, metallic balls is one which tends largely to diminish the 
power of the animal for doing harm, by obviating to a great ex- 
tent the danger from punctured wounds to which those who han- 
dle them are exposed. The best mode, however, of secui'ing cat- 
tle while standing, is by tying the head up to a post or a tree, or 
again by yoking an individual with his mate or another animal of 
the same species. Kicks must also be guarded against. Those 
by the fore legs are avoided by raising one foot and tying it on 
the forearm, thus compelling the animal to stand on three legs. 
But the hind legs of cattle are the most dangerous from their 
abiUty to kick in so many directions, whether backward, forward 
or outward. 

Several methods are recommended by which to guard against 
this form of danger. Among these may be mentioned the passing 
of the tan forward between the hind legs and then outward, car- 
rying it towards the stifle of the leg from which the kick may pro- 
ceed, and holding it firmly with a backward pull ; thus surround- 




*^s^-.^:iiSr_^,AV-2^ _J\--:i!i^^^^ 



Fig. 42.— To Prevent Cattle from Kicking. 



56 



MEANS OF RESTBAINT. 



ing or tying the leg with the tail. Again, to pass a twitch round the 
leg above the hock, and to turn it until the tendo-Achilles pressed 
upon, is brought in contact with the posterior face of the leg. A 
loop of rope twisted upon a stick will answer the same purpose. 
The use of hobbles, single or double, or of the side lines to secure 
the hind legs, has also been recommended, as with solipeds, with 
the difference that the horns furnish a strong means of support, 
which is entirely lacking in the soliped. A method approved by 
some of controlling the motion of the animal is to pass a rope on 
one hind leg above the fetlock, and to carry this leg well forward, 
or even to raise it from the grovmd and to tie it by the rope to the 
forearm of the same side above the knee or around the horns. The 
use of a long bar of wood held under the abdomen by two assist- 
ants in front of the stifles ; keeping the animal pressed against a 
wall by means of a wooden bar, with which an assistant pushes 
firmly against the stifle of the side opposite to that upon which 
the operator stands ; binding the animal against a wall with a rope 
fixed to a ring in front of the chest and one behind the hind quar- 
ters — all these are simple means employed to keep cattle quiet in 
the standing position. 

Some individuals, however, and especially bulls, are altogether 
intractable, and require more severe and effectual modes of pun- 
ishment. These are appHed upon the muzzle of the animal in his 
nasal septum by nippers or clamps, or with rings. Nippers are 
of divers forms. One true, single clamp is commonly used in 
Italy, and has been modified in England ; another is in use in Hol- 




Fig. 43.— Italian Fig. 44.— Modified FiGS. 45 A and B.— Modified English 
Nose Clamp. English Nose Clamp Nose Clamps. 



SECUEING OTHER DOMESTIC ANIMALS. 



57 



land,, which is a true screw-clamp ; another, which is preferred in 
France — are a few among the varieties of this single instrument 
for the application of pressure upon the septum nasi. They are 
generally secured on the front of the face by ropes or straps. 
They are effectual appHances, and by their aid the head can be 
kept up and the animal controlled without difficulty. Among the 
rings the simplest are most commonly in use. They are made in 
two parts, articulated at one extremity, and united at the other 
when in place by a rivet or screw. They vary much both in form 
and size. Some (though still known as rings) are square ; others 




3 



Fig. 46.— Square (?) Rings for Cattle, 

are round and eUiptical. The ling of Rolland, the Alsace ring, and 
some of simpler construction carry an auxiliary ring at some part 
of their circumference with which to secure them on the face of the 
animal by means of ropes or straps. These rings are appHed after 
the perforation of the nasal septum with a trocar or a punch-nip- 
pers, making an opening of a size corresponding to that of the 
ring. Sometimes the perforation is made with a hot iron, the 




Fro. 47.— Ring of RoUand. 

anirnal being properly secured and tied to a tree, or placed in a 
yoke with the head elevated, the operator making a quick punc- 
ture through the cartilage, and introducing the ring and riveting 
it. The hemorrhage soon ceases spontaneously. 

In order to dispense with the punch, trocar, and the puncture 
with the hot iron, rings of a special construction have been in- 
vented. These also consist of two parts, and are also articulated, 



58 



MEANS OF EESTEAINT. 




Fig. 50.— Puncture of the Septum witli Trocars. 




i 



Fig. 51 —Rings with Points. 



SECURING OTHER DOMESTIC ANIMALS. 



59 



one of the joints having a sharp point with -which the ring is 
pushed through the cartilage. A simple form represented in 
Figure 51 shows the point passing thi'ough an eye at the other 
extremity of the ring to be bent over it in order to close the in- 
strument. The ring used in some parts of France is contrived 




Fig. 53.— French Kings. 



somewhat on the same plan, but is more compHcated. That of 
Rueff is a kind of broken circle, which, when closed, forms a per- 
fect ring in which the branches are kept together by a small screw. 




Fig. 53.— Ring of Rueff. 

The rope which is attached to the nasal ring is not always suffi- 
cient to drive or control bulls, and conductor sticks armed at the 
end with iron hooks of various shapes are recommended. The 
apparatus of Vigan is a very simple one, but it fulfils all require- 
ments and suffices for the restraint of the most vicious animals. 
It consists of a wooden pole with an iron prolongation having a 
wide ling by which to hold it, and at a short distance from this a 
hook to be inserted into the nose ring. Back of this is a strajD to 
secure around the horns the bar over the top of the head as it passes 
between the horns. At the other extremity is an iron stifle through 
which a surcingle is passed to be tied around the body of the 
animal. Painful, and stni easy to apply, this apparatus is not 
only a powerful means of restraint, but is siofficient to prevent 
any motion of the head. 



60 



MEANS OF RESTRAINT. 




Fig. 55.— Vigan'B Apparatus. 



SECURING OTHER DOMESTIC ANIMALS. 



61 




Fig. 56.— Steer Placed in Stock. 

The use of stocks for the control of bovines is often also re- 
quii'ed. These are used principally in shoeing oxen, but are 
available for some operations which require greater passiveness 
than can be obtained by the applications of the simpler means 
above described. It is only in exceptional cases, and when an 
operation is likely to be unusually painful and prolonged, that the 
recumbent position is required with bovines. 

The casting of cattle may be effected with or without hobbles, 
but in either case special care is necessary to provide a sufficiently 
thick bed to protect the head, and guard against the possible 
danger of fracturing the horns. A long board placed transversely 
across the neck, with an assistant seated on each end, affords an 
excellent means of controlling his efforts and struggles. When 
hobbles are used, they must be of smaller size than those used for 
horses, and should be placed above the fetlocks. 

To cast bovines without hobbles, either of two methods, one 
invented by Eueff of Germany, and another described by GweU 
and Hertwig, will answer the purpose. In the first, the Rueff 
method, a rope some thirty-six feet long is required, in the middle of 
which a loop is made and fixed round the base of the horns. The 
two free ends are then passed between the fore and the hind legs, 
each being twisted from within outwards, around one of the 
coronets, and brought back to the loop at the base of the horns, 
through which they are passed to assistants, one on each side, 
with directions to pull backwards. The feet are thus brought 
close together, and the animal seats himself on his hind quarters. 



62 MEANS OF EESTEAINT. 

and finally stretches himself on the bed. If he struggles, the 
traction on the ropes only expedites the fall. If he pushes for- 
ward, or attempts to kick or even only moves his feet, the running 
of the rope is so much more facilitated. 

In the other mode, a rope about the same length and carrying 
in one extremity a loop which is thrown over the horns, is passed 
backwards along the superior border of the neck, as far as about 
its middle, where a loose loop is made ; then carried backwards 
at the side of the vertebral column, where another loop is made, be- 
hind the shoulders, and a third one around the abdomen, on a level 
with the flank, where an assistant holds it backwards by the side 
of the sacrum. If the animal is to be thrown on the left side, the 
rope must pass on the right of the base of the tail, and vice versa. 
Two assistants pull on the rope, while another holds the head and 
tries to bring the animal down. The traction on the ropes tight- 
ens the three loops, and under the effect of this force the animal 
is made to lie down quietly. It facilitates the operation to lubri- 
cate the rope with a little grease or soap. 

In order to avoid compUcations from lacing the ropes too 
tightly about the body, it is always indicated to subject the pa- 
tient to a moderate fast previous to casting by this mode. 

(b) OviNES AND Capkines — Although these animals are timid 
and comparatively lacking in strength, they are at times capable 
of struggling violently and becoming dangerous, and they can- 
not be subjected to surgical treatment without being cast. This is 
done by grasping both legs of one lateral biped, the right fore and 
hind legs, for instance, and laying him over on the opposite side, the 
left, and vice versa. If all the legs are to be secured, those of each 
lateral biped are first tied, and with the two cords a straight knot 
is made, binding all together. 

If the seat of operation is the head, the animal is held by an 
assistant, who sits with the body of the animal between his legs, 
with its back close to his own body, holding the fore legs with his 
hands, and controlling the hind quarters between his legs. In 
some cases when the operation is light, the oj)erator holds the an- 
imal himself without help. 

(c) Swine. — Securing a good hold of this animal is not always 
an easy task, and it sometimes requires not a little skill and ciui- 
ning to do so. When seized, two assistants are necessary to cast 
him, especially if he is of large size, and when down, either a muz- 



SECURING OTHER DOMESTIC ANIMALS. 



63 



i 




Fig. 57.— Twitch for Swine. 

zle must be put on his snout to prevent Ids biting, or a peculiar 
twitch placed between his jaws and twisted over the upper one. 

If an examination or operation is to be made about the mouth, 
a wooden gag placed between the jaws and held with cords, will 
be found of great utility. The various operations performed upon 



c 




D 



Fig. 58.— Gag for Swine. 

the noses of swine, to prevent them from digging the ground, may 
be considered to some extent as means of restraint. The incision 
of the snout, which consists in making several transverse cuts 
through it; the nasal tenotomy, though not so successful; the 
application of rings through the nose, by the same methods as 




Fig. 59.— To Prevent Swine from Digging. 



64 



MEANS OF EESTRAINT. 




Fig. 59a.— Another Mode. 



those used in cattle, are simple means which only need mention, be- 
ing more frequently performed in fact by raisers and breeders of 
swine, and indeed rather belonging to their special domain than 
to that of the professional veterinarian. 




L '^' 

Fig. 60.— To Prevent Dogs from Biting. 

(f?) Dogs and Cats. — Dogs can be prevented from biting by 
muzzling them, or vdth a cord or band wrapped first around the 
lower jaw, and then around both, and secured over the neck behind 
the ears. 

To examine the mouth in the absence of a speculum, as the 
one represented in Figure 61, the mouth may be held open by 
cords passed around each jaw behind their tusks, and pulling 
them apart. If the animal is dangerous or ugly, the collar nippers 



SECURING OTHER DOMESTIC ANIMALS. 



65 




Fig. 62.— Keeping the Mouth of a Dog Open, 




Fig. 63.— Collar Nippers for Dogs. 

become very handy, in order to hold them by the neck and keep 
them under control, whether for operation or for administration 
of medicines. 

Cats are most difficult to handle. They bite and they scratch, 
and they are often unconquerable until they are fully subjected to 
general anesthesia. In many instances, the co-operation of a good 
assistant, accustomed to handling them, may be found necessary. 
They may sometimes be made amenable to treatment by grasping 
them by the neck behind the ears, and close to the head with one 
hand, and securing the fore paws with the other, while a second 
assistant holds the hind legs, or it may become necessary to have 
the four paws tied tightly together, and only the head held by the 
assistant. 

We have heard of the utilization of a man's boot as a means of 
feline restraint, particularly ia the castration of the male, or 
" Tom," the head and body of the animal being thrust into the leg 



66 MEANS OF RESTRAINT. 

of the garment, leaving only the posterior portions exposed and 
accessible to the operator. This may not be a scientific device, 
but its effectiveness can hardly be doubted. 

SUEGICAL ANESTHESIA. 

A resort to the various means of restraint, which we have been 
considering, is sufficient in a majority of cases to bring imder 
perfect control such animals as require to be subjected to surgi- 
cal treatment. But there is a class of cases in which they become 
inadequate to meet the great requirements of inducing in the pa- 
tient a condition in which a great diminution, or the entire 
suspension, of sensibility and consciousness, with all power of 
muscular reaction, is established throughout the organism. This 
result is obtained through the characteristic action of the special 
therapeutical compounds, known as anesthesia. 

It is not merely as a more effectual means of securing control 
over refractory patients that their administration is justified. It is 
also prompted by a proper humanitarian feeling in cases in which 
severe and prolonged suffering accompany the operation. 

In veterinary surgery, the indication for anesthesia, has not, to 
the same extent as in human, the avoidance of pain in the patient 
for its object, and though the duties of the veterinarian include 
that of avoiding the infliction of unnecessary pain as much as 
possible, the administration of anesthetic compounds aims prin- 
cipally to facilitate the performance of the ojjeration for its own 
sake, by depriving the patient of the power of obstructing, and 
perhaps even frustrating its execution, to his own detriment, by 
the violence of his struggles, and the persistency of his resist- 
ance. To prevent these, with their disastrous consequences, is the 
prime motive in the induction of the anesthetic state. That it per- 
fectly succeeds in fixing the patient in the attitude most favor- 
able for the surgeon in the execution of the various parts of his 
task, needs no affirmation, nor need we attempt to measure the 
value of the discovery, which has proved itself to be such a price- 
less benefaction to the world. 

There are special cases where anesthesia is more particularly 
necessary than in others, and where absolute immobility of the 
patient is essential, and entire muscular relaxation indispensable. 
Thus it is indicated in the reduction of fractures or dislocations in 



SUEGICAL ANESTHESIA. 67 

the large domestic animals ; in cases of delicate manipvdation 
and dissection with sharp instruments, as in the operation for 
strangulated inguinal hernia; in the reduction of other hernial 
tumors, in the performance of neurotomy; in operations upon 
the eye, and in the removal of tumors of certain kinds. It is also 
indicated in certain operations upon the foot, which are always 
accompanied with great pain, such as that for the extirpation of a 
portion of the quarter of the foot, in the removal of the cartilage 
affected with necrosis (quittor); or again, in deep punctured wounds 
of the sole, where the resection of the plantar aponeurosis becomes 
necessary, or the bones are scraped with the knife. 

The anesthetic condition is also very favorable for the reduc- 
tion of displaced organs, as of a prolapsed rectum, or uterus, or 
bladder. 

In operations upon the teeth, in some cases of parturition, 
in castration, in firing, or even in the application of hobbles, the 
induction of the anesthetic state has often been of great benefit 
in quieting nervous animals, and subduing them to a condition of 
passiveness, which reheved the movements of the surgeon from 
aU embarrassment and uncertainty. 

As with human patients, anesthetics are contra-indicated in 
animals subject to diseases of the heart or of the lungs. A fuU 
stomach is also always a contra-indication of their administration, 
especially in soHpeds, which are lacking in the abihty to relieve it 
of its contents by vomiting. 

Anesthesia may be either local or general, according to the 
area of its effects. Local, when apphed to the skin over a Hmited 
surface, to which its effects are confined ; and general, when ad- 
ministered by inhalation, and through the respiratory organs in- 
fluencing the entire economy. 

In local anesthesia the effects are obtained either by the pulveri- 
zation of the proper substance upon the region where it is required 
to take effect, or by the subcutaneous injection of special agents. 
General anesthesia is usually produced by the inhalation of the 
vapors of ether or of chloroform. 

LOCAL ANESTHESIA. 

The special indications for this are so numerous that they may 
almost be considered as general, if not universal, and its applica- 
tion is so simple and easy a process, and its effects usually so cer- 



68 



MEANS OF RESTRAINT. 



tain, that it would become the practitioners of our day to utilize 
it more frequently and extensively than they do. It is available 
as well as useful in the simplest operations, and may be employed 
in the opening of abscesses and cysts ; in the puncture of cold 
abscesses with the hot irons; in the puncture of the cornea; in neu- 
rotomy ; in simple incisions of the skin ; in the removal of small 
tumors, etc., etc. We have used it with the best results in ureth- 
rotomy, in caudal myotomy, in amputation of the tail, and the 
removal of mammary tumors in dogs, etc. Bouley long ago rec- 
ommended its application to surgical diagnosis, in cases of doubt- 
ful lameness, an expedient which has recently been introduced into 
this country by several veterinarians, for the differential diagnosis 
of shoulder and foot lameness. 

We have remarked that the anesthesia can be produced in 
several ways, though two are principally in use. Among these 
properly termed minor and secondary expedients, are the applica- 
tion of cold water or ice, and cooling or freezing mixtures, and 
pressure upon the blood-vessels and nerves, which have for years 
been among the adjunct and agencies of surgical practice, but 
have given place in recent times to methods more potent and 
more certain in their effects. Notwithstanding this, however, 
some mention of their nature and qualities, and the methods of 
utilizing them will not be out of place, if only as a matter of gen- 
eral reference, and a case might arise in practice when the infor- 
mation might become practically valuable. 

1st. Pulverizatio7i of an Anesthetic Liquid. — The apparatus 
employed for this process is the invention of Dr. Richardson, and 
though the spraying tube has been from time to time more or 




Fig. 64.— Richardflon Atomizer. 



LOCAL ANESTHESIA. 69 

less modified, the mode of its employment continues unchanged ; 
though any substance susceptible of easy pulverization may be 
employed. Ether is the agent most frequently chosen. Rigolene 
has given us great satisfaction in our own practice. 

In impingiag upon the skin in a state of excessive division, 
the rapid evaporation of the Hquid lowers the temperature of the 
surface with which it comes in contact, and it is this process of 
refrigeration which diminishes the local sensibility, and, as the 
effect increases, overcomes it entirely for the time being, or so 
long as the spray continues to be thrown upon the part. 

Some sHght objections, however, may be alleged against this 
mode of producing insensibility, arising from the special proper- 
ties of the fluid employed, and for this reason the mode by sub- 
cutaneous injection is somewhat to be preferred. 

2d. Subcutaneous Injections. — Both ether and chloroform 
have been recommended, and extensively used, in this manner, 
but without doubt the salts or compounds of cocaine possess ad- 



PiG. 65.— Syringe of Pravaz. 

vantages over either of them. An epidermic syringe, or that of 
Pravaz, is generally used for the purpose, with a solution of from 
four to twenty per cent, strength, according to circumstances. 

If used on a tumor a certain quantity of the solution, perhaps 
twenty drops, is injected under the skin at two or three points 
around its circumference, the desired effect following, and the 
parts being ready for the operation within from eight to ten 
minutes, more or less, according to the strength of the dose 
administered. Either of these modes of local anesthesia is harm- 
less, and may be employed without risk or fear of complications. 



70 MEANS OF KESTKAINT. 

GENEKAL ANESTHESIA. 

The three principal agents which recommend themselves by 
the efficiency and certainty of their action in producing general 
anesthesia, are ether, chloroform and chloral hydrate. Their 
adaptation varies, however, with the animals subjected to their 
administration. Chloroform and chloral are chiefly used for the 
larger animals, principally horses, while chloral and ether are re- 
served for the smaller kinds, with which chloroform is so 
generally dangerous, and even so often fatal, that its use with 
them is almost entirely discarded. 

Insensibility by Anesthetic Va^yors. — The modes adopted for 
the inhalation of the vapors of chloroform are numerous, but 
among them all the merit of simplicity should probably be award- 
ed to that which is recommended by Bouley. This consists in 
the introduction into each nostril of a small sponge, or a ball of 
oakum, saturated with the ether or chloroform, and held in 
place by the hands of assistants. The inhalation of the vapors, 
which are thus mixed with air, proceeds rapidly, the sponges 
being recharged as soon as they become exhausted, and returned 
to the nostril, rmtil the object in view is accomplished. But 
while this mode is a very convenient one, we conceive it to be 
liable to certain objections. 

First, unless the pouring of the liquid is very carefully per- 
formed and in such quantity that the sponge is not over-saturated, 
there is danger that a large portion of it may be wasted, by run- 
ning off, either on the bed, or possibly, into the nostrils, causing, 
in the latter case, great irritation of the mucous membrane. 
And if the anesthesia is to be continued for a considerable length 
of time, the effect produced upon the delicate membrane of the 
nose may be sufficiently serious to end in the sloughing of the 
parts. It must certainly have been with the view of avoiding 
this complication that Defays invented the inhaler shown in 
figure 66 with its wide range of appHcation, from the dog to 
the horse. 

Many veterinarians have adopted an arrangement consisting 
of a strong leather muzzle with large openings at its bottom and 
sides for the free admission of the atmospheric air, the sponge 
or oakum charged with the chloroform or ether being placed in the 
bottom of the muzzle, which is fixed upon the animal's head in the 



GENEKAL ANESTHESIA. 



71 




Fig. 66.— Apparatus of Defays. 

ordinary way. This is a very convenient, though quite a simple 
contrivance, but English veterinarians, and among them Mr. R. 
Cox, recommend in preference a chloroform-bag, in the form 
of an ordinary bag, made of strong canvas, both ends of which can 
be closed by a running string, one being tied around the nose 




Pig. 67.— Cox's Chloroform Bag in Position. 

while the bag is secured by cords to the halter or to the straps 
of the caj). The chloroform is introduced into the bag by means 
of a thin j^iece of cloth saturated with the liquid. 

The chloroform nose-cap recommended by Mr. Gresswell also 
answers a very good piu'pose, and in fact, possesses advantages 
which render it superior to the apparatus of Mr. Cox. It is not 
so portable in its form, but is more durable in its construction. 
In fact, it produces the features of the ordinary stable muzzle 
which we have already mentioned. 

The apparatus of Carhsle is also one of English invention, for 
which great merit is claimed. We have used it, and the trial has 
shown it to possess many features of marked superiority over the 
others. 

The quantity of liquid required to bring a large animal under 
complete general anesthesia cannot be positively ascertained. 



72 



MEANS OF RESTRAINT. 





Fig. 68.— Gresswell's Chloro- 
form Nose-Bag. 



Fig. 69.— Carlisle's Chloroform Inhaler. 



While it has often been induced by the inhalation of a single 
ounce, there are cases in which two, three, or even more have 
been necessary. An essential point to consider is that the 
chloroform should be absolutely pure. Mixtures of two or more 
drugs have also been employed, usually ether and chloroform, 
with or without the addition of alcohol, but the result of all ex- 
perimental tests has been, with us, to establish the conviction, 
that as yet, chloroform used singly has proved itself to be the 
most effective and the safest of all. The administration of 
chloroform of course pre- supposes, besides all the other conditions 
and preliminaries of an operation, such as previous fasting, the 
preparation of the bed, and other incidental steps, the act of 
throwing the patient. 

When the effects of the inhalations begin to become manifest, 
the first physiological change noticed is an extreme agitation, 
accompanied with coughing. The animal struggles more or less 
violently, the irritation and tickling of the throat produced by the 
vapors upon the laryngeal mucous membrane, giving rise to a 
spasmodic motion of the glottis, and whether the patient be a 



GENERAL ANESTHESIA. 73 

large or a small animal, he exerts his strength to rid himself of 
the apjsaratus and regain his freedom of motion. 

These manifestations are, however, but of short duration, and 
are soon followed by a state of passiveness, the respiration be- 
coming easier, the cough disappearing and his energy subsiding ; 
and in short, he is subdued. The eye then assumes its character- 
istic expression, its brilHancy is lost, it is wide open, the pupils 
slowly dilate, the gaze becomes fixed, the sensibility of the cornea 
is lost, and the light ceases to effect it. The mouth becomes 
more or less loaded with saliva ; the pulse, which must be carefully 
noted by an assistant, becomes slow and weak, the respiration 
returns to its normal condition ; the state of complete anesthesia 
has been reached, and the patient, in happy unconsciousness, is 
ready for the surgeon. 

The time required to reach this condition varies with the sub- 
ject, and especially with the quality of the drug administered. The 
average period is from one to five minutes in small animals, and 
from ten to fifteen in the large. In some few cases, however, half 
an hour may elapse before complete insensibility is produced, and 
again animals are encountered with pecuhar idiosyncrasies, which 
remain entirely refractory, and successfully resist every attempt 
to reduce them to insensibility ; a statement equally true when 
applied to human patients. 

The duration of the Anesthesia. — Some animals remaining 
under the influence only for a few minutes, sometimes from fifteen 
to thii'ty or forty, it becomes necessary to prolong the insensibil- 
ity by renewing the inhalation, and they must, therefore, be con- 
tinued until the completion of the operation. Recovery from the 
anesthetic state does not always take place immediately and per- 
fectly. As the effect begins to subside, the animal, having parti- 
ally regained his senses, begins to move his eyes, raises his head, 
perhaps allows it to fall back slowly on the bed, lying flat on his 
broadside ; then his legs begin to move, and presently he attempts 
to spring suddenly to his feet. He may succeed in doing so, but 
again, his muscles may not have yet recuperated their power of 
full action, and there may be danger of his experiencing a heavy 
fall on the bed. His condition is one of drunkenness, and he re- 
quires to be watched, and, if necessary, aided, in order to prevent 
him from injuring himself by efforts beyond his strength whUe 
in a state of weakness of which he is unaware. 



74 . MEANS OF RESTRAINT. 

The symptoms of general anesthesia by chloroform, which we 
have detailed, are those of ordinary cases. There are, however, 
other symptoms which the vigilant operator will not fail to look 
for, which are of great importance as indicative of the dangers, 
and premonitory of some of the casualties incident to the situ- 
ation. These we reserve for subsequent consideration. 

Anesthesia by the Admmistration of Chloral. — While this 
drug and its compounds, as sometimes used, produces in some 
cases a condition of insensibihty quite as complete as that ob- 
tained by chloroform or ether, yet there are cases in which only a 
less complete degree of success can be secured, though still suffi- 
cient to be of great assistance to the surgeon as weU as of rehef 
to the patient. That the intra- venous injection of chloral has been 
shown to be the best of all modes of obtaining anesthesia, is an 
admitted truth, but unfortunately it is a method of introducing it 
into the system which will scarcely ever become sufficiently prac- 
ticable to be available outside of the laboratory. Efforts to over- 
come the difficulty referred to have not been wanting, however 
and Messrs. Cadeac and Mallet have experimented with chloral by 
combining its action with that of muriate of morphine. By first 
injecting subcutaneously a certain quantity of a solution of mor- 
phine, and following it after a few minutes by a rectal injection 
of a solution of chloral, they have obtained complete anesthesia 
in a very short time. For a horse they have used eighty centi- 
grammes to one gramme of the morphine, and from eighty to one 
hundred grammes of chloral; and, for a dog, ten centigrammes of 
morphine and twenty grammes of chloral 

The administration of chloral in the form of balls, as commonly 
practised by many veterinarians, in doses varying from one to one 
and a half ounces, given on an empty stomach, and from one to two 
hours before the operation, is imdoubtedly good practice. We 
have not personally had the opportunity of testing it in cases of 
long and tedious dissections, but the benefit we have often de- 
rived from it in short, though painful operations, justifies us in 
recommending it, not only for this very object, but in any case, 
where, from any possible cause, an animal is likely to receive severe 
injuries during his struggles to liberate himself. 



ACCIDENTS OF GENERAL ANESTHESIA. 75 

ACCIDENTS OF GENEKAL ANESTHESIA. 

Notwithstanding the caution observed in the use of ether or 
chloroform, and however pure these articles may be, accidents must 
be expected during their administration. They are not always of 
a serious nature, but they may at times have fatal results. 
Among those of minor importance is the cough which becomes 
at times quite troublesome, but may be readily subdued by a tem- 
porary arrest of the iahalation ; vomiting, which often occurs in 
small animals, but which can be guarded against by causing the 
patient to fast long enough to insure an empty stomach before 
being etherized, and spasmodic contractions, of which the exis- 
tence, when undoubtedly present, is often overlooked. Among 
those of more serious nature are syncope, either cardiac or res- 
piratory. 

Cardiac syncope is a very serious accident, and in a majority 
of cases proves fatal, especially in large animals. It is sudden in 
its manifestation, and often unobserved until at too late a period 
of the oj)eration. It is due to a gradual diminution, followed by 
an arrest of the muscular contractions of the heart, and as far as 
oiu* observation extends is always associated with pre-existing 
heart disease. The apj^Hcation of cold douches, of heart stimu- 
lants, ammonia given by inhalation or internally, are the first in- 
dications in these cases. 

Respiratory syncope, which is far less dangerous, arises from 
the influence of the laryngeal nerves upon the activity of the res- 
piratory centers. Its access is sudden, being caused by the arrest 
of the respiration. There is no convulsion, though the intoxica- 
tion produced by the anesthetic vapors is sudden in its effects, and 
is generally detected only by careful watching. 

The application of electricity, that of the electro-puncture, and 
especially persevering efforts to effect artificial respiration, may 
sometimes save the animal, provided the trouble is not connected 
with the complete arrest of the contractions of the heart. 

In view of these possible incidental conditions, some general 
rules suggest themselves tending to their avoidance. Great care 
and exactness in gauging the doses of the anesthesia, with such 
caution in their administration as to produce a slow and gradu- 
ated effect, is one point. Free allowance for the introduction of 
air with the vapors inhaled ; close attention to the state of the 



76 MEANS OF RESTRAINT. 

circulatory and respiratory apparatuses, and the manner in which 
their functions are executed, by noticing the heart-beat and watch- 
ing the pulse and the movements of respiration at the flanks, are 
other points of importance. 

Another point is the need of bearing in mind that an animal 
submitted several days in succession to general anesthesia be- 
comes more and more susceptible to its effects, and therefore 
more exposed to the dangers they imply. 

ACCIDENTS INCIDENTAL TO THE USE OF MEANS 
OF KESTRAINT. 

We have already considered some of the accidents which are 
likely to interfere with the successful application of the means of 
restraint, and especially with reference to the final act of the pre- 
liminary series which occur at the moment of throwing the animal 
and depositing him on his bed, jjarticularly such as may follow 
the neglect of properly protecting the head with the cap or 
blinkers, or by an unnecessarily prolonged use of the twitch, or 
from the sudden and violent movements of the animal himself. 
These can usually be obviated by proper forethought and watch- 
fulness. But the most careful attention cannot always assure 
immunity from miscarriage and casualties. Thus, a common mis- 
hap, and one which cannot be anticipated nor prevented, is the 
sudden and heavy faU of the animal just as his equihbrium is lost. 
The lesions which may follow this casualty may have their seat 
either in the hard or soft structures, and are of the most serious 
character, not only including, at times, fractures and dislocations, 
and lacerations of the soft tissues, including the muscles, but may 
affect the viscera, and even the blood vessels and the nerves — in 
this last case involving the parts in all the evils of local paralysis 
and its disabilities. 

(a) Feactuees. 

This form of injury may have its seat in the vertebral column, 
the ribs, and the bones of the extremities. 

1st. Fractures of the Vertebral Column. — In the list of frac- 
tures, those of this region of the body are the most frequent. 
The numerous reports of cases which are made public by veterin- 
ary writers furnish sufficient evidence of the facihty and frequency 
of their occurrence, even when the most careful attention has been 



ACCIDENTS DUE TO RESTKAINT. 77 

bestowed on all the details of the work of casting. The very 
peculiar circumstances uuder which these spinal fractures some- 
times take place, baffling calculation, and occurring when least 
expected or prepared for, illustrate the responsibility which the 
veterinarian assumes, and the culpabihty with which he would 
become chargeable by undertaking the work without due caution 
and preparation, or without notifjang the owner of the animal of 
all the hazards and difficulties attending the case in all its steps 
and stages. As will be seen when we come to the consideration 
of this special lesion in the chapter on fractures, the symptoms 
which accompany this accident are distinguished, as to one feat- 
ure, by the suddenness of their appearance, which takes place at 
the moment of the infliction of the injury or immediately after. 
But the most important of the characteristics of the case is the 
grave fact that the fracture is almost always of the comminuted 
kind. This is held to be due to the excessively powerful mus- 
cular contraction, resulting in the over-arching of the vertebral 
column simultaneously with pressure from the abdominal organs, 
caused by the sudden extension of the anterior and posterior 
bipeds, bound together with hobbles, the violence of the struggle 
so powerfully pressing the vertebrae together as to result in the 
yielding of their spongy structure ; and the crushing or grinding 
of the bone is the consequence. 

This theory of the production of fractures of this character 
has been adopted by the majority of European veterinarians, es- 
pecially by those of France, where it is understood as "Bovdey's 
Classical Theory." In 1889, however, another theory was pro- 
pounded and defended by Mr. Moussel, of Alfort, differing en- 
tirely from that of Bouley, in which he claims that the kind of 
fracture in question is not caused by an over flexion of the spine, 
but, on the contrary, is the effect of an excessive extension ! result- 
ing from greater contraction of the ilio-spinalis muscle. 

According to Dicker hoft, " three factors are active in the cau- 
sation of these fractures. In the first place, the animal must have 
some object as 2, point d^ appxd for one hind leg; that point must 
be connected with either one of the other extremities or directly 
with the trunk. * * * Secondl}-, the horse must make his vertebral 
column teiise by the contraction of the spinal extensor muscles 
* * * Thirdly, the horse must, simultaneously with the extension 
of the hiad leg and that of the vertebral column, draw its pelvis 



78 MEANS OF EESTKAINT. 

to one side. * * * But no one of tliese three elements, in itself, 
will produce a fracture; they must all concui-." 

Whatever may be the value of these theories, the fact that at 
post-mortem examinations fractiires have been discovered, in some 
cases in the annular portion, and in others in the body, seems to 
prove that any one of them is equally applicable with another. 

To prevent these fractures, therefore, becomes the principal 
object of the surgeon at the critical moment when the animal is 
thrown. This involves a strict attention to the rules which we 
have laid down for his guidance in the various steps of the act of 
casting; and, moreover, to have recourse, as often as possible and 
as the indications suggest, to the aid of anesthetic agencies, and 
by no means to ignore the value or neglect the use of the appa- 
ratus of Bernardot & Buttel. 

2d. Fractures of the Hibs. — These fractures are undoubtedly 
frequent, as the result of heavy falls upon a badly-made bed — too 
hard or too thin, or perhaps concealing hard substances, as stones 
or the like. 

3d. Fractures of the Pelvic Bones. — There are but few cases 
on record of this kind of injury, but they are possible, as the re- 
sult of carelessness in the preparation of the bed or improper 
casting, or powerful muscular contraction. 

4th. Fractures of the Hones of the Extremities. — Though prob- 
ably less common than those last referred to, these lesions are not 
unknown in veterinary practice. They occur principally in the 
diaphyses of bones, or near to, or at the epiphysis, and are often in- 
complete in their nature. Delafond describes a case of fracture 
of the femur taking place during the application of the clamps 
while undergoing the operation of castration ; and another case is 
recorded of which the trochanter of the femur was the seat. Rey 
has reported a case of fracture of the cubitus taking place as the 
animal, when freed from the hobbles, made a violent effort to spring 
from the bed uj)on which he had been thrown to be fired for a 
chronic enlargement. These fractures of the extremities may be 
avoided by careful attention, not only at the time of throwing the 
patient, but in placing him in position and in properly securing 
him, and giving him judicious assistance in regaining his feet. 

5th. Dislocations. — These accidents are of very rare occur- 
rence. One case, however, is recorded of a dislocation backwards 
of the humerus, complicated with fracture of the cubitus. 



INJURIES TO SOFT TISSUES. 79 

(b) Injuries to Soft Tissues. 

1st. Laceratio7is of JIuscles mid their Annexes. — These are 
the result of the distorted positions into which the extremities are 
forced wMle undergoing operations. They may be discovered 
immediately, or may be developed a few days after the operation. 
Inflammation of the olecranean and pectoral muscles, of those of 
the croup, and of the anterior part of the shoulder have been re- 
ported. Bouley has seen a rupture of the aponeurosis of the great 
and of the small oblique muscle of the abdomen, and one rupture 
of the flexor metatarsi. A case of laceration of the diaphragm is 
recorded by Bouley, Jr. In one of our own patients, laceration of 
the olecranean muscles was followed by such severe compHcations, 
that it l^came necessary to destroy the patient. 

2d. JHuptures of the Viscera. — These are of rare occurrence, 
being generally prevented by the precaution of refraining from 
throwing the animal, until assured of an empty digestive canal by 
previous fasting. Accidents, however, have been witnessed by 
Gohier, who has noticed their occurrence upon the rectum near 
the anus. This horse had drunk freely of water before being 
cast. Bouley, Jr., has seen a case of rupture of the diaphragm. 
Rey has known one of the heart, Schaak one of laceration of the 
humeral artery, and even the giving way of the vena cava, in a case 
of a nervous animal upon which means of restraint were being 
applied to dress a small wound. The patient suddenly fell, and, 
struggling violently, died ; and at the post-mortem the abdomen 
was found full of blood, and the vein torn back of the kidneys 

3d. Injuries to JVerves. — These are accompanied with loss of 
power, usually temporary, but sometimes permanent. The posi- 
tion in which it is sometimes necessary to fix an animal, as in the 
diagonal, is that in which they are most likely to occur. The 
symptoms of paralysis which are then manifested, betray them- 
selves when the animal has just risen from the bed, when, upon 
being called upon to move, the leg is discovered to be unable to 
carry its weight, flexing upon its various bony levers, and render- 
ing locomotion impossible. Sometimes these symptoms are of 
but short continuance, and disappear vmder the influence of strong 
stimulating frictions. The leg was, according to the popular 
phrase, "asleep," because of a temporary arrest and sluggishness 
of the circulation. But in other cases, the condition is brought 



80 »:eans of eestbaint. 

on by a true lesion of the nerves, the brachial, the lumbar plexus, 
or some of their branches having undergone some traumatic hurt 
which may prove more or less refractory to treatment. 

4th. Asphyxia. — According to Peuch and Toussaint, this ac- 
cident may result from the ignorance of assistants, who, in con- 
trolling the animal and keeping him down on the bed, have com- 
pressed the nostrils too tightly ; or again it may be caused by the 
excessive pressure of the throat straps of the halter, or of the rope 
which encircles the neck when a horse is placed in position for 
castration. To explain the causes of this accident should be, with 
an intelligent operator, sufficiently to hint the means of prevent- 
ing its occurrence. 

Conclusions. — A review of the matters we have been considering 
in this chapter may not be out of place, nor unprofitable even at 
the risk of being, perhaps, a little repetitious. In view of the oc- 
currence of these accidents, and appreciating the responsibility 
assumed by the surgeon when about performing an operation 
upon a more or less valuable animal, he cannot but be conscious 
of the obligations which impose themselves upon him to take every 
precaution to avoid them. He should therefore guard against 
their eventual contingency, by closely inquiring concerning the 
condition of his patient, and by satisfying himself that every part 
of the apparatus of restraint is in good order ; should avoid rough 
treatment and employ anesthesia when possible, and never put an 
animal in a constrained position for treatment when an operation 
can be otherwise performed more advantageously and easily and 
comfortably to his patient, and he should never allow him to re- 
main in his restrained and compulsory recumbent position longer 
than is strictly necessary. And above all, he should never under- 
take an operation without having fully acquainted the owner of 
the animal of the possibility of accidents. The fact of thus ex- 
plaining matters to an owner, and of obtaining his intelligent con- 
sent does not, of course, relieve the surgeon of his responsibility, 
but rather, on the contrary, confirms and increases it by thus add- 
ing a new, though an implied pledge to his employer to devote 
his most conscientious endeavors and exercise his best skill in the 
matter, in token of his appreciation of the confidence placed in his 
skill and faithfulness. 



CHAPTEE n. 
SURGICAL DIAGNOSIS. 

The first query to be settled in examining a diseased animal is 
whether the ailment with which he is attacked is merely a case of 
disordered function, requiring only the administration of the 
proper drugs to restore the usual order of things, or a case de- 
manding the operative skill £ind expert ministrations of the sur- 
geon, with bistoury and cautery and suture. The decision of this 
query involves a thorough knowledge of anatomy, and is compara- 
tively more diSlcvdt, as well as more important, than the mere 
medical diagnosis of diseases pertaining to internal pathology. 
Errors in surgical diagnosis are always both more dangerous and 
more important than those of a mere medical character, inasmuch 
as they are likely to be more readily exposed, and to involve a 
greater amount of responsibihty on the part of the surgeon. 

To insure the certainty of his diagnosis, the surgeon must call 

iato exercise all his resources of knowledge and experience, and 

employ all his faculties of observation and discrimination, with 

such instinimental aid as may serve to facilitate and confirm his 

conclusion, as to the nature of the cases before him. He must 

» 

especially employ all his organs of sense in the investigation. A 
single sense is sometimes sufficient to diagnosticate the character 
of some special lesions, but more commonly each sense is an 
auxihary of the others, and all are complementary to each. In 
fact, the surgeon is not justified in reaching a conclusion as to the 
detection of an affection, which is discovered by the sight, 
or touch, or smell, or hearing, alone, but to escape the possibility 
of error, he is bound to confirm his discovery by the corroboration 
of another, or what is still better, of all the others, if possible. 
In these cases, as in others, the eye is the most valuable and 
comprehensible of the organs. 

1st. Sight. — Visible changes of contour, or color, or other 
deviations from the usual appearance of tissues, or of regions, are 
of co\irse first made known through the sight of the eye. De- 
formities, unless of very minute dimensions, with abnormal 



82 



SURGICAL DIAGNOSIS. 



growths, prominent swellings and changes of direction in the 
bony levers, belong to the same category, and if these are not suf- 
ficiently distinct or conspicuous, and seem likely to escape the 
visual observation of the surgeon, a careful measurement may de- 
cide the point. The eye must also discern the changes occurring 
in the various visible membranes, as for example, the heightened 
redness of a congested membrane, and the paleness of an anaemic 
subject. 

Again, if there is abnormal motion in a part, as in fractures 
and dislocations, it is to the eye that the disclosure is first made. 
This application and study of the use of his eye wiU be very 
serviceable to the surgeon in the examination of the external sur- 
face of the body, but when examinations within the organism, or 
within its cavity, become necessary, however strong a Hght he 
may have at his disposal, he will be compelled to have recourse 
for assistance to the speculum, to hold the parts open. 
There are many forms of this instrument. 

The speculum oris, for the mouth, has very numerous shapes, 
some of them very simple, as in Figures 70 and 71, and some com- 




FlGS. 70 & 71.— Simple Speculum Oris. 




Fig. 72.— Brogniez Speculum Oris. 



plicated, as in Fig. 72, the speculum of Brogniez. Green's spec- 
ulum is an American invention, simple, safe, comfortable to the 
patient, and of easy manipulation (Fig. 73). Grange's mouth 
speculum is rather clumsy and heavy (Fig. 74). These instruments 
are generally employed for solipeds. Placed between the jaws, 
they open the mouth forcibly, and keep it so as long as they con- 
tinue in place. 

Sometimes, however, the mouths of these animals, as well as 
those of ruminants, can be held open without them, by putting 



SIGHT. 



83 




Fig. 74.— Grange's Speculum. 

the tongue out of one side of the mouth with one hand, while the 
cheek is pulled out in the opposite direction with the other. 
This same manipulation may answer for large ruminants, provid- 
ing the head is kept elevated by an assistant. In s"^dne, a gag 
(See fig. 58) made of wood, is often used, and the speculum rep- 
resented in figure 61 answers well for dogs. At other times, 
however, with these animals, the mouth is kept open by separat- 
ing the jaws with tapes passed around each, and pulled apart. 



84 



SURGICAL DIAGNOSIS. 




Fig. 75. — Reynal's Mouth Reflector. 

Reynal is the author of an instrument which facilitates the 
examination by the eye of some jparts of the mouth. It is 
polished on both surfaces, and acts as a reflector, and, when in- 
troduced on the inside of the cheek, will help to detect diseased 
spots on the teeth, which would otherwise escape discovery. The 




Fig. 76.— Nose Speculum. 

speculum to dilate the nostrils and examine the nasal cavities, 
also acts as a reflector, but fails, we think, to fulfill the object, 
for lack of sufficient dimensions. It is made somewhat on the 
principal of the vaginal speculum used in human medicine, and 
acts in the same manner. 





Fig. 77.— Eye Speculums 



SIGHT. 



85 




Fig. 78.— Ophthalmoscope. 

The speculum to keep the eyehds apart will be found of great 
assistance in the examination of that organ, so sensitive to the 
light when in a state of disease, and so constantly kept closed on 
that account. It is, in fact, this speculum which renders the use 
of the ophthalmoscope practicable for the examination of the in- 
ternal structures of the ocular globe. 

Some of the various patterns of the speculum used in human 




Fig. 79.— Examination of Dog's Ear. 



86 



SURGICAL DIAGNOSIS. 



surgery for the ear, will be found available in the examination of 
the external auditory canal, especially in dogs. The dilatation of 
the vagina and the anus is scarcely ever needed in veterinary 

surgery, and instruments are there- 
fore not required j nor is the endo- 
••*'CS^"::S^::^-s._ scope, so useful in human sur- 




gery, of any value in veterinary practice from 
the impossibility of using it upon animals. 

To realize the value of these optical aids 
in the examination of cavities, a strong light 
is indispensable. Sometimes the ordinary 
solar rays will be sufficient, but at others reflected and concen- 
trated artificial light will be necessary, as in the use of the oph- 
thalmoscope to examine the eye, or to detect the conditions of the 
deep posterior parts of the nasal cavities. 

(b.) Touch. — The taxis is the surgical sense ^:)ar excellence, 
and is probably the more valuable and reUable of all the means of 
investigation possessed by the surgeon, the sight itself not ex- 
cepted. Nothing else so accurately detects the changes in the 
proportions, in the consistency, in the elasticity, or even in the 
nature of tissues, and its discoveries may be made serviceable at 
every stage of an operation of importance and delicacy. But to 
attain a reliable certainty in the exercise of this tactical skill, the 
finger ends must, equally with the eye, be thoroughly educated to 
perform their functions with accuracy and discrimination. A 
change in the aspect, form and contour of a region which 
easily escapes detection by an ordinary observer, will become 
instantly evident to the well-drilled digital extremities of the ex- 
perienced operator. 

The object requiring examination is not always, however, 
within reach of any portion of the hand, and resort must be had 
to instrumental aid in the exploration of parts deeply situated, or 
of fistulous tracts, and for this purpose the j^robe is brought into 
requisition. It is usually of metallic material, generally silver, or 
of lead, or may be made of gutta percha or whalebone, or other 



TOUCH. 



87 




Fig. 81.— Straight, cvirved Directory— Silver Probe. 



suitable, flexible substance, and either straight or curved as the S 
probe. The dii-ector is also a probe, heavier than the ordinary 
kind, and having a small groove running its length on one side. 
It is used as a kind of guide to prevent the deviation of the bis- 
toury from its proper course, and to conduct it to the bottom of a 
wound. 

Exploring needles are used with advantage in the detection of 
the nature of abnormal growths, the small and narrow wound 
which they make being sufficient to ascertain the nature of the 
liquid which may be present, without danger of compHcations. 

The Dieulafoy aspirator affords another means of exploration 
and discovery of deep-seated parts, inaccessible in the ordinary 
way. 




Fig. 82.— Dieulafoy'8 Aspirator. 



88 SUPvGICAL DIAGNOSIS. 

(c) Hearing. — The indications obtained through the media 
of the sight and the touch may be usefully supplemented, and are 
often completed by those which address the sense of hearing. 
The gurgling soiind iu hquid or gaseous tumors, the peculiar 
bruit in aneurisms, caused by the current of the blood; the con- 
tact of a stone ia the bladder when touched by the exploring 
catheter ; the peculiar glou-glou of the entrance of air into a vein ; 
the characteristic crepitation of fractures, and the whistling of a 
roaring horse — these, and other signs, convey their information 
with unmistakable distinctness to the auricular sense. 

{d) Smell. — The exercise of the olfactory sense in the formation 
of a surgical diagnosis is more limited than those just con- 
sidered, and yet there are conditions in which it may be of great 
importance. 

The odor, sui generis, of gangrene and of necrosis are 
promptly detected, and at once recognized, and the existence of 
other pathological conditions, as of urinary or stercoral fistulous 
tracts, and certain affections of the feet, are betrayed by the 
pungent and aggressive appeal to the olfactory organs. 

(e) Taste. — As free from anything like fastidiousness ia 
respect to offensive contacts and surroundings, as the surgeon 
must imavoidably become, he draws a line ; he insists upon a 
strict monopoly of his gustatory sense for his own internal uses, 
and only investigates the domestic animals in an alimentary way, 
when entirely healthy individuals are reduced to b, post-mortem 
condition by the butcher, and served in the form of beef, mutton 
and pork, properly cooked. But if the surgeon should desire 
much valuable aid from the exercise of the physical senses in form- 
ing his diagnosis, he will commit a serious error if he allows 
himself to be entirely and exclusively guided by them. Strictly 
speaking, a direct diagnosis may sometimes be arrived at by a care- 
ful collation of the results of his researches, but he will often, 
also, be obliged to modify or go beyond these conclusions, and 
make an indirect diagnosis besides. 

There are two ways of making a positive surgical diagnosis : 
one which maybe caUed the direct, or diagnosis by confirmation ; 
another known as indirect, or by exclusion. The former is by 
ulterior investigations, confirming a previous diagnosis made upon 
the basis of a single and prominent symptom ; the latter by the 
elimination of all diseases, which, though they may have some 



TASTE. 89 

resemblance to that whicli has been suspected, yet are excluded 
by the presence of some specific and incompatible symptoms. 
It is only by carefiil induction and cautious reasoning, that 
the surgeon can settle the question of his diagnosis, and insure 
such a true and tangible conclusion, as can only be reached when 
there is a perfect correspondence between the suggestions derived 
from the testimony of the physical organs, and the calm deduc- 
tions of the logical faculty, aided by a disciplined and well fur- 
nished memory. 



CHAPTEE III. 
SURGICAL THERAPEUTICS. 

This title refers to one of the most extensive and important 
departments of surgical practice, upon which, indeed, as to its 
proper administration, depends in a great measure the success of 
the operative skill, of which it is the supplement and consummation. 
It comprehends the bandaging and dressing of traumatic iajuries. 

DEESSINGS. 

Gourdon says that " a dressing is a mode of local, periodically 
repeated, treatment, producing a continued action, following or- 
dinarily the performance of operations, and consisting in the 
methodical application upon the surface of wotmds of special 
apparatuses, which complete the effect of the operation, and co- 
operate in the recovery." 

The value of the skni and proficiency to be acquired by dili- 
gent study and observation in this comprehensive and indispen- 
sable art, need not be stated ; that it is entitled to be so denomin- 
ated no one acquainted with the niceties of its details and the 
judgment and experience entering into their performance, need be 
told. Nor can the dependence of the surgeon, for the good results 
which he hopes to secure in his department of duty, upon the 
faithfulness and intelligence of the nurse, who is to co-operate 
with him in perfecting the healing process, be easUy overrated. 
An incompetent or unfaithful nurse, may spoil the best work of a 
good surgeon. To protect a wound from immediate contact of 
surrounding bodies, to shield it from injurious atmospheric effects, 
malarious or otherwise; to keep aloof all putrid and virulent mat- 
ters ; to secure the absorption and neutralization of their morbid 
products; to control the cicatrizing process in the ulcerated 
parts ; to apply topical treatment, according to indications, as 
the curative processes develop ; to produce a mechanical action, 
such as dilatation or compression, according to the instructions 



DRESSINGS. 91 

of the surgeon, and the indications of the case. Such is a fair, 
though brief synopsis of the duties of the nui-se, upon whom it 
devolves to give effect to the rules of surgical therapeutics. 

A well-applied dressing may become the first step toward 
assuring the success of an operation, those following it — even 
when only methodically executed — being mere continuous degrees 
of the one well begun action. A well-apphed di-essing may sup- 
ply the defects and amend the errors of an improperly performed 
operation; and, on the other hand, a bad dressing may jeopardize 
the success of a well-executed operation by interfering with the 
process of cicatrization, and in other ways delay the recovery of 
the patient, and even prevent it entirely, by causing unfavorable 
complications. 

The application of all dressings is subject to certain general 
rules, from which no deviation is allowable. As in every action in 
life, the first step should be that of preparing all the necessary 
means and appHances for the work, and the last, before beginning 
the actual manipulation, should be to ascertain that nothing more 
remains to be provided, at the risk of a serious interruption and 
delay, and loss of time in a search for some missing article of 
necessity. On such a point the merest hint should be sufficient, 
and, indeed, even a hint should be unnecessary with a practical 
and thoughtful person; but, unfortunately, all persons are not 
practical and thoughtful. 

The next step for the surgeon is to secure for himself and his 
patient a favorable arrangement in respect to Ught and room. 
There must be nothing interposed before the eye, or that can limit 
the free movement of the hand and the arm — a most obvious sug- 
gestion. 

Before applying a dressing, the wound should be thoroughly 
cleansed and freed from blood, pus, the remains of previous 
dressings, and, in a word, of any foreign or other substances 
capable of becoming sources of irritation. This is best done 
with water alone, but its effect is frequently greatly improved by 
combining with it some of the compounds, such as carboUc acid, 
sanitas, creoline, etc , which have proved their value as antiseptic 
agents. It may be applied by carefiilly passing a fine sponge or 
a ball of oakum over the surface of the wound, or it may be used 
more freely in larger ablutions. Crusts or scabs, if any, may be 
removed with the scissors or scraped away with the sjiatula, but 



92 SURGICAL THEEAPEUTICS. _ 

1 

the finger-nails must by no means be used for such a purpose* 
for the twofold reason that it is both filthy and dangerous. 
Handle the wound only as much as is necessary; all needless 
taxis irritates — the inference is obvious. If the wound is deep, 
injections can be combined with the lotions in cleansing it. 

With the first dressing, there is probably only blood to wash 
away, and that should be done thoroughly, not overlooking any 
portion that may have dried in the hair and on the skin. The 
essential condition of cleanliness applies not only to the wound, 
but also to the material used for the dressing, and soiled cloths 
or bandages, and dirty tow or oakum must be rigorously rejected. 
And, while insisting on strict cleanliness in the instruments and 
dressing material, it will hardly be decorous to the surgeon to 
omit him from the category, and to remind him of the propriety 
of looking to his own condition, and especially to that of his 
hands. 

In all his manipulations it should be a matter of conscience 
with the surgeon to treat his patient kindly. Eough handling, 
loud scolding, threatening or jerking, with a restless animal, to 
punish him for an instinctive and natural attempt to move under 
the infliction of pain, will not only be of no service, but, on the 
contrary, wiU increase his fright and render him all the less docile 
and willing to submit in quietness. 

In applying the various parts of the dressings, unnecessary 
pressure should be avoided, especially on soft tissues ; and when 
it is indicated, it should be applied by slow degrees, and as uni- 
formly as possible, packing the wound upon its entire surface, 
and completed only as the dressing is nearly ended. Assistants 
should be enjoined to observe the same rules. The dressing 
should be applied, not hastily, but rapidly; not with the idea of 
saving time, simply with a view to lose none. The fact of avoid- 
ing any waste of time, by working without needless pause, has, 
moreover, the excellent effect of curtailing the sufferings of the 
patient, and sparing him much needless pain. 

It is always important to watch the effect of the various arti- 
cles of dressing as they are appHed, in order to be certain that 
they cause no pain either at the time, or at a later period by their 
shape, the roughness of their surface, or their unskillful applica- 
tion ; and above all, that they cause no interference with any of 
the essential functions of the economy, as the respiration or cir- 



DRESSINGS. 93 

culation. This last especially may be impeded by excessive pres- 
sure. To avoid this, bandages applied upon one of the extremities 
of the body should be so placed as to direct the pressure from the 
periphery toward the center. If apphed in the opposite direction, 
more or less strangulation might result, causing considerable 
swelling below the bandage. In fact, all unnecessary or exag- 
gerated pressure is liable to cause inflammatory swellings, erysip- 
elous engorgements, or local gangrenes. 

The maintenance of an equal and regular pressure will obviate 
all danger of deformities of parts, and when methodically applied 
upon irregular wounds, wherever needed, will serve to restore or 
preserve them in the natural contour of the region. Neatness 
and finish should be studied as much as possible, but not, of 
course, at the expense of any of the special and essential objects 
of the dressing. 

Besides these general rides there are others relating to minute 
points and touching the various elements, which, as a combined 
whole, constitute the completed transaction, such as those relating 
to the topical treatment, to the material used, to the rollers or 
bands, and to the bandages proper. The medicinal compounds 
used for topical treatment are either appHed alone or through the 
medium of other materials. They are of various natures and con- 
sistencies, from that of the almost impalpable vapor used for 
spraying, to the liquid forms in the numerous watery solutions, 
alcohohc tinctures, and oils or liniments, to the hard and 
other solid compounds in the various astringent, absorbing, stimul- 
ating or caustic powders, or the soft pharmaceutical mixtures, 
the cerates, the pomades, the ointments, the plasters, poul- 
tices, etc. 

The appUcation of the material used should receive attention 
from the surgeon. An invariable rule should be to avoid all ir- 
regularity, roughness and unevenness, and to be careful that the 
exterior application rests upon a regular and uniform surface. 
For this reason it should be the order, in applying this material, 
always to begin by using the smallest portions, increasing gradu- 
ally to the largest, thus filling first the small infractuosities and 
making an even surface, to be covered with larger ones and thin 
pads, then with thicker ones, and finally with those of the widest 
dimensions, which should bear a margin extending somewhat be- 
yond the outlines of the wovmd. The entire dressing is to be 



94 STJKGICAL THEKAPEUTICS. 

maintained in position by means of compresses, rollers or band- 
ages, as the case may require. 

Eollers are long bands of muslin, linen, or ticking, or broad 
tapes, whicli are used principally in dressing wounds of the ex- 
tremities, or of regions liable to much motion. Their length and 
width vary, according to the requirements of the case. The sur- 
geon will do well to assure himself of the dimensions of these, 
and to ascertain that the rollers are of ample length, with some- 
thing to spare, which excess in length can be cut off. Deficiency 
in the length of a roller will interfere with a perfect completion 
of its application. If too wide, it may prove difficult to apply it 
neatly, while if too narrow it may have a tendency to act like a 
ligature, and make even pressiire difficult, besides being more 
liable to slip and become loosened. Rollers are applied either dry 
or moist. When moist, they become loose in drying, and their 
action becomes insufficient. Dry rollers ought, therefore, to be 
preferred. 

Bands or rollers are prepared in two ways, either by being 
rolled on one or on both of their extremities, and are therefore 
called the single or the double roUer. In applying it, the extrem- 





FiG. 83.— Single and Double Roller Bandage. 

ity is first folded tightly to make a small cylinder, which is held 
by its extremities between the thumb and index finger of the left 
hand, resting by its width between the same fingers of the right ; 
and while the fingers of the left hand turn the small central cylin- 
der, the band is rolled upon it to its end. Rolling on both ends 
is done in the same manner. When half of it is rolled, a pin will 
secure it and prevent it from becoming slack until the other half 
is made ready to be used. In rolhng the bands, slight traction 
should be made at intervals by the thumb of the right hand, while 
the fingers of the left keep the central cylinder steady — the object 
of which is to have the roller firm, hard and solid. 

In large establishments, or even in private practice where 
great numbers may be required, the use of the small apj^aratus 
represented in Figure 85 will be found very advantageous, the 



DRESSINGS. 



95 




Fig. 84.— Manner of Koliug a Bandage. 

band being rolled upon the central rod with facility, and when 
removed having the necessary qualities of a well-rolled bandage. 
The general manner of applying a roller bandage is very simple. 
Placing with one hand the end of a single roller, or the middle of 
a double one, upon the part to be covered, and keeping it steadily 
in position, the other hand holding the mass of the bandage with 




Fig. 85.— Bandage Roller. 



96 SURGICAL THERAPEUTICS. 

the roll turned upward, gently draws on it away from the start- 
ing point, unrolls it, and with it surrounds the entire region in 
returning to the starting point. This process is continued until 
the band is exhausted, when it is secured by j)iiis or by strings. 
Thus applied, it may be laid in a circular manner, when the turns 
rest exactly upon each other, or in a spiral manner when they 
overlap each other in part of their width, or in a crossed or figure 
of eight manner, when the turns cross each other to meet always 
at a given point. If they are applied upon cylindrical surfaces, 
the folds generally He smoothly and evenly upon each other as 
they are successively formed, but if the region is of conical shape 
or otherwise irregular in form, one of the borders will adapt itself 
more readily to the parts than the others. Hence the formation 
of bulging parts or pockets, which render the smooth and proper 
application of the bandage very difficult, and may interfere with 
its sohdity. This is avoided by giving to the roller an obUque 
half twist, which, while it changes the gaping border in its posi- 
tion, prevents the slackening of the bandage and removes the 
pocket. This is principally required in the bandaging of the lower 
part of an extremity (Fig. 86). 

The application of bands on double rolls is also subject to the 




Fig. 86.— How to Apply a Bandage. 



DBESSINGS. 97 

rules we have given. The completion of the process by the appli- 
cation of the final dressings and proper finishing steps can scarce- 
ly be subjected to rules which could not well be framed to meet the 
varieties in the features and circumstances of the diversified cases 
constantly occurring in practice. The only strictly general rule 
that can be estabhshed, is, that when a bandage is placed on the 
outside of a dressing, it must always, first of all, be fixed at the 
points which are the most essential to secure it and maintain it in 
its proper place. 

The proper time for the removal or change of a dressing, is a 
question which depends for an answer upon the consideration of 
the nature of the wound, the season of the year, the age and con- 
dition of the patient ; in fact upon all the various circumstances 
which in the judgment of the surgeon may influence the progress 
of the cicatrization. 

On general principles, the first dressing is not to be removed 
untn the suppui-ative process is thoroughly established, which is 
towards the fourth or fifth day. But there are cases where special 
circumstances indicate an earHer or a later removal. For example, 
if the dressing has been appHed to control the hemorrhage of a 
divided blood vessel, from twenty-four to thirty-six hoiu-s are 
generally svifficient to obtain the obHteration of the vessel. 
Again, while it is justifiable to leave the dressing of a foot, which 
has been subjected to an operation, for eight, fifteen, twenty, and 
even twenty-five days without changitig, and especially in these 
days of antiseptics when so much is possible in the way of com- 
bating the suppurative process, there are no doubt cases where 
it must be looked after earHer, as where there is an exhibition of 
increased pain, instead of the abatement which might be justifi- 
ably looked for if the operation and the dressing had been 
properly executed; the increase of pain indicating some compli- 
cations which early exposxu'e might easily have controlled. There 
ai'e, however, conditions where the removal of a dressing is ra- 
dicated in some more than in others, as, for instance, when sup- 
puration is abundant. In these cases, to prevent the retention of 
the pus in the wounds, and to diminish the danger of its pres- 
ence, or of its absorption, or facilitate its escape, drainage tubes 
must be used, or the dressing changed. 

The removal of a first dressing usually involves an attention 
to minute details not subsequently required, the various parts 



98 SURGICAL THEEAPEUTICri. 

which compose it beiag often impregnated with blood and glued 
together by concreted pus, causing, if removed carelessly, the 
laceration of tissues, tearing of granulations, hemorrhages, etc. 
It must especially be ascertained whether adhesions exist between 
the material of the dressing, and if they are present they must 
be thoroughly soaked by means of compresses wet with tepid 
water, or a warm water bath, if the dressing is upon a region 
which allows it, as, for instance, one of the extremities. When 
this is done, the various constituents of the dressings may easily 
be removed, one by one, but care and dehberation will still be 
necessary. The smaller particles should be removed vnth the 
forceps, not the fingers. If the location allows it we even prefer 
to wash these away by irrigation, with a stream of luke-warm 
water, or by soaking thoroughly in a foot bath. The wound is to 
be cleaned out carefully, by soaking or 8ox>ping away the pus with 
fine sponges, avoiding all rubbing upon the granvdations or caus- 
ing them to bleed. Then studying all the indications, to be dis- 
covered in the condition of the wound, and avoiding aU unneces- 
sary manipulations, and attentively removing all causes likely to 
interfere with the repairing processes, the dressing is to be re- 
placed with aU the original precautions. As little time as possi- 
ble, consistent with thoroughness, should be occupied in this 
process. The wound should be uncovered only as long as 
necessity requires, the materials for the dressing being aU easily 
accessible without delay or hindrance, being prepared in advance 
and carefully inspected. 

The effects looked for in the application of dressings can be 
divided into general and special, these varying in their nature, 
according to the object which the surgeon has in view. The 
first and principal object is to protect the wound from exposure 
to the action of the atmosphere, and also against contact with 
foreign bodies, thus to relieve the pain, diminish the inflammatory 
irritation, and accelerate the cicatrization. It also prevents the 
retention, by their absorption of the suppuration and serosity 
which form on the surface. They also expedite recovery by 
maintaining the natural warmth of the body in the region. 
The special effects of dressing, vary according to the special 
action produced by their application, and these may be considered 
under several heads. 

(a) Retentive dressing. — This is designed to keep parts in their 



RETENTIVE DRESSING. 99 

normal condition and situation, and thus aid in their union or con- 
sohdation, without deformity. It is principally apphed in cases of 
fractures or dislocations, but finds also its main indication in 
maintaining in their proper place the medicinal substances which 
are the active agencies of cure. 

(b) Uniting dressing. — That which is made with sutures or 
adhesive plaster, to hold the parts in their proper position, and 
maintain their perfect co-aptation. 

(c) The suspensory dressing, which is a variety of the reten- 
tive dressing, and serves to support organs of soft texture in 
some parts of the body, such as the testicles, or the mammae, 
which by their position are exposed to traumatism by their sit- 
uation, their weight, and by puUing and bruises. Suspensories, 
is the name given to these special bandages; they are commonly 
used in diseases of the testicles, and of the udder. 

{d) Comjyressive dressings. — These are devised to produce 
more or less active pressure upon a too active granulating sur- 
face ; to arrest hemorrhage, to change the vitaUty of some tissues 
of a morbid nature, or to control the projection of abnormal bony 
growths. 

(e) The dividing dressing is the opposite to the uniting. It 
is of common use in cases where too rapid closing of wounds is 
to be prevented. It is apphcable in infundibuliform surfaces, in 
deep fistulous tracts, and in wounds which are the seat of foreign 
elements, pathological or other. It operates by keeping the 
superficial opening of the wound dilated, by means of tents, 
sponges, etc. 

(/') Expidsive dressing. — The object of this dressing is to 
assist the exit of pus from the surface of wounds. A simple dress- 
ing, by its absorbing properties, is somewhat of an expulsive na- 
ture. The presence of a single tent of an absorbing quahty, as 
small balls, or padding of absorbent cotton; the application of 
drainage tubes ; all these faciUtate not only the escape of the 
secretions, but also the discharge of the morbid products. The 
drainage is obtained by the introduction into the wound of India 
rubber tubing, of various dimensions, perforated at intervals upon 
their length, and kept in position by safety pins inserted through 
them and the skin, at suitable points. These tubes, when extend- 
ing through the depth of a wound, embracing its whole length, and 
projecting through a counter opening, as well as through the 



100 



SURGICAL THERAPEUTICS. 




Fig. 87.— Safety Pins. 



natural ones of the wound, form an excellent means for contin- 
uous irrigation, in the treatment of fistulous withers, compHca- 
ted poll evil and other diseases. 

{g) Antisejytic dressing. — Is intended to prevent the entrance 
of micro-organism into wounds, to neutralize their morbific ef- 
fect, to check their development, and thus prevent their septic in- 
fluences from taking effect. The application of the Lister dress- 
ings, with the care required ia the preparation and application 
by the surgeon ; of the instruments and materials included in the 
arsenal of pharmaceutical resources, comprising the antiseptic 
sprays; the various acids, boracic, carboHc, and salycilic; the 
alkahne sulphites and hyposulphites; permanganate of potash; 
solutions of bichloride of mercury and of creoline; antiseptic 
gauze and absorbent cotton — all these, and more constitute dress- 
ings essentially germicide, which caimot be too confidently 
recommended to the attention and adoption of the veterinary 
siu'geon. 

The apphcation of the wadding dressing, so highly recom- 
mended by some, has given, in our hands very satisfactory 
results, in many cases. Wadding well prepared and properly 
applied, forms an almost invincible obstacle to the introduction 
of micro-organisms, and according to Pasteur, by its direct action 
upon the pus renders fermentation impossible. 

The instruments necessary for the adjustment of dressings, 
are generally speaking, numerous and varied. They consist of 
forceps of all kinds, the ordinary dissecting, the buU-dog, the 
straight, and the curved dressing forceps; scissors, directors, 



ANTISEPTIC DRESSING. 



101 




Fig. 88.— Dissecting Forceps. 




Fig. 89.— Bull-Dog Forceps. 




Fig. 92.— Syringe for Dressing. 



smtulas the S. probe, and others; syringes, and sometimes 
liters, and also razors, enter mto the list of those generally 

"'The materials used to form the base of the dressings va^ : 
charpie, wadding, wool, moss and sponges, are «*^ . f « 
costLss as respects their commercial value, is probably he 
reason why they are not more generally adopted m the 
prlL ot veterilrians. Oakum is the material, par e^elUnce, 



102 SURGICAL THERAPEUTICS. 

for the apj)licatiou of dressings in veterinary surgery, and is even 
commonly used in human surgery. We are almost tempted to 
claim for it the distinction of having been especially created for 
the benefit of wovmded horses, its various and valuable qualities 
so obviously fitting it for the uses to which it is appropriated in the 
equine cHnic. It is excellent as a defense against the contact of 
external bodies, and in preserving a uniform temperature in the 
parts covered by it. From the sponginess of its consistency it 
readily soaks and absorbs the fluids which form upon the surface 
of a wound, while the tar with which it is more or less impregnated 
confers upon it slight antiseptic properties, which assist in the 
stimulation, and are in themselves favorable to all the processes 
of cicatrization. To be of good quality, it must be clean, soft to 
the touch, and free from any foreign substance. Sometimes it is 
cut into small portions for use, but more generally in strips, or 
in such other special shapes as may be required. It is made into 
balls by spreading out little masses of the fibres, which after being 
separated from each other, are rolled between the hands, into the 
required forms and sizes. They are exceedingly convenient in 



Fig. 93.— Ball of Oakum. 

constituting the first steps of this application of a dressing. It is 
also made into ^x^ds or cushions, by stretching the fibres parallel, 
into any given width and length, and folding them into the simil- 
itude of a small mattress. This must be soft, and free from 
lumps, or fragments of wood, and of an even thickness through- 




Fig. 94.— Pad of Oakum. 



out. These are made also of various dimensions, the widest and 
thickest being used to cover the outside of the wound. It is also 
shaped into dossils, rolls, and tents, or plugs, the adaptation of 
which remains yet to be considered. 



BANDAGES. 



im 



BANDAGES 

The catalogue of means and appliances for dressing is by no 
means exhausted ia those already mentioned. Among them are 
the various forms of compresses, the rollers, the splints, the plates 
and the means of drainage, with the various forms of rolled ban- 
dages, wide bandages and mechanical bandages. 

(a) Com2')resses. — These are pads made of linen, of various 
sizes and shapes, and folded to any degree of thickness required, 
which are sometimes appHed immediately upon the wovmd, but 
usually upon the oakum. They are not, however, of frequent use 
in veterinary surgery, except imder special indications. They 
may be square, long, triangular, shaped like a neck-tie, or like a 
Maltese cross, either complete or half, double or treble-tailed, and 
generally patterned and graduated according to the form required 



'fe'l'^g'^'Kil Tl!..':'ll.!.!lil:lini'ilil 

Fig. 95.— Square Compreds. 



Fig. 96.— Long Compress. 




Fig. 97.— Triangular 
Compress. 



Fig. 98.— Neck-Tie Compress. 





Fig. 99.— Maltese Cross Complete. 



Fig. 100.— Half Maltese Cross Complete. 





Fig. 101.— Double Compress. 



Fig. 102.— Treble Compress. 



104 



SUKGICAL THERAPEUTICS. 





Fig. 104.— Perforated CompresB. 



Fig. 103.— Graduated Compress- 



by the case. They are commonly used in their entire thickness, 
but are sometimes made with a hole in their center, and then 
receive the name of perforated or fenestrated. 

(b) Hollers have already occupied our attention. 

(c) Splints. — These are long, flat, and more or less rigid strips 
of wood, or other material, designed to be added to other dress- 
ings, to give them some peculiar form or position, and to consoli- 
date and strengthen them by increasing their rigidity. They are 
usually a]3plied upon the extremities or superior j)arts of the body, 
and are composed not only of wood, but of hard leather, paste- 
board, tia, gutta-percha, etc., etc., and maintained in position by 
bands or adhesive mixtures. They must be carefully and accu- 
rately appHed in order to avoid chafing or excoriating the skin, 
and are often padded, and their borders made especially smooth 
and uniform. 

(d) Plates. — These are small pieces of metal or wood, ueed 
pruicij)ally in the surgery of the foot, to keep ia place dressings 
of the plantar region, which require more or less pressure upon 






V 



7 



Fig. 105.— Plates on Shoes. 



BANDAGES. 105 

their surfaces. They consist of separate parts or sections, repre- 
senting together the entire surface of the sole, one section sliding 
on each side, between the foot and shoe, and are kept in place by 
a third and narrower section, introduced transversely between them 
and the shoe, towards the heel. It is important to ascertain, be- 
fore applying them, that sufficient room exists between the sole 
and the shoe, and also that the wall is not in such close contact 
with the shoe at the heels as to prevent the introduction of the 
cross pieces. 

(e) Means of Drainage. — The conduit most commonly used is 
a vulcanized india-rubber tube, which is introduced into wounds 
to facilitate the escape of purulent and other discharges, and to 
keep them in a cleanly state. They are of various dimensions, as 
to the length and diameter, to accommodate those of the purulent 
cavity, and are perforated at the side throughout their length, in 
order to collect and receive all the impurities that may be present. 
Instead of tubes, long tents of oakum are sometimes introduced 
into a wound, for the piu-pose of absorbing the impurities, and to 
serve as a means of di'ainage also. 

{/) Holler Bandages. — These are the simplest of bandages. 
They are applied with one or several rollers. We have already 
mentioned their division into cii'pular, spiral, figure 8, etc. 

(f/) Wide Bandages are made of broad, thin pieces of linen, 
ticking or canvas in various forms, to adapt themselves to any 
part of the body where they may be needed. They are sometimes 
folded into pads or cushions, and employed as a means of applying 
moisture. Those invented by Dr. Berns (Fig. 106) for this purpose 
may be used with advantage. They are kept in place by tapes 
or ribbons, which must be arranged and fastened about the body 
according to the judgment and ingenuity of the surgeon. 

The number of wide bandages is indefinite, and, according to 
Bourgelat, twenty-seven species can be classified and enumerated. 
He would prove himself, however, but an indifi'erent practitioner 
who should find himself unable, upon occasion, to improve the 
catalogue by adding new devices to meet new i-equii-ements. 

In examining some of the principal varieties of the wide ban- 
dage, we shall borrow from the excellent work of Peuch and 
Toussaint. Our reference will -be to 

Ist. Simple Frontal. — This is a piece of cloth covering the 
greater part of the forehead and the summit of the head or poll, 



106 



SUBGICAL THEKAPEUTICS. 




Fig 106 -Berns Moistened Pads 

with a fold superiorly to receive the forelock or toupet, and se- 
cured by four bands. The lower two have either a small opening 
or loop, which the upper two pass before extending down below 
the throat, to cross each other in the form of an X, and drawn 
upwards in the lateral faces of the head to the poll, where they 
are held (Figs. 107, 108). 

2d. Compound Frontal. — This is shaped like the former, 
but extends further down on the face. It has six bands, the 
middle ones having also loops at their free extremity, as in the 
preceding, the upper ones being also secured in the same manner, 
the lower ones crossing each other under the jaws, and also 
carried upward to pass through the loops of the middle bands, 
to be either tied on the i)oll, or drawn downwards and tied in the 
maxillary space (Figs. 109, 110). 



BANDAGES. 



107 





Fig. 107 —Simple Frontal (full view) Fig. 108.— Simple Frontal (side view). 





Fig. 109.— Compound Frontal (full view). Fig. 110.— Compound Frontal (side view). 

3d. Monocular or Simple Bandage for the Eye. This is an 
oblong square, notched at the angles, corresponding to the ear of 
the same side, and provided with two transversal folds, to adapt 
itself to the convexity of the orbit. It is secured by five bands. 
The upper three are attached to the throat-strap of the halter or 
bridle, the lower two to the lower part of the same strap (Figs. Ill, 
112). 

4th. Binocular or Double Bandage for the Eye. — This is 
formed of a large piece of cloth, notched on its two superior an- 
gles to receive the ears, and secured with eight strings or straps. 
A longitudinal fold in the upper, and another in the lower part 



108 



SUKGICAL THERAPEUTICS. 





Fig. 111.— Monocular Band (full view). 



Pig. 112.— Monocular Band (side view). 



of the bandage, facilitate its adaptation to the surfaces it is to 
cover (Figs. 113, 114). 

5th. Bandage for the Maxillary Region. — This is of triangular 
shape, and is formed either of sheepskin or of two layers of cloth, 
between which a pad of oakum is sewed. It is furnished with 
four straps. When appHed, the base of the triangle is turned 
backward, and the apex rests in the angle of the maxillary space. 
The two upper straps, attached at each angle of the base of the 
triangle, pass upward at the side of the parotids, and are tied on 
the summit of the head, the two lower ones attached at the apex 
of the triangle, passing over the nose to be tied at that point. "We 
have often obtained a better adaptation of this bandage by utiliz- 
ing the cheek or the nose-piece of the halter 

6th. Ear Bandage (Figs. 115, 116). — This is made of two trian- 
gular pieces of cloth, united at their base on the summit of the head, 
each forming a kind of inverted pocket, with which the ears are 
covered. It is secured by six bands, the two superior having loops 
through which the middle ones pass, these crossing each other 
under the throat and extending upward to be tied on the poll. 
The lower bands cross each other on the forehead and pass under 
the head, to retiu'n on the lower part of the face where they are 
secured. Another way to apply a dressing on the ear to envel- 
ope it properly is to use a thin bandage, which, after it has envel- 
oped the ear, is passed around the head on each side, and secured 
under the throat (Figs. 117, 118). When supported by a tightly 



BANDAGES. 



109 





FIG. 113.— Binocular Band (full view). 



Fig. 114. — Binocular Band (side view). 





Fig. 115.— Ear Bandage (fuU view). 



Fig. 116.— Ear Bandage (side view). 



fitting halter this bandage maintains its position in a manner quite 
satisfactory. To this kind of bandage can be added the one used 
for dogs imder the name of co^?, which is made of soft cloth or fine 
cord net. The caps recommended by the Germans answer the 
purpose also very well (Figs. 120, 121). 

7th. Bandage for the Parotids or Throat. — This bandage is 
long and square, and is notched in the middle of the two borders 
to secure the inferior border of the neck, and adapt itself to the 
maxillary space. It covers the parotid, and is secured by four 



110 



SUKGICAL THERAPEUTICS. 




Fig. 117.— Bandage for the Ears (side view). 





Fig. 118.— Bandage for the Ears (full view), PiG. 122 —Parotids Band. 

bands, two attaclied in front of the forehead, the others on the 
poll. This bandage is often combined with that of the maxillary 
region, and made in a single piece (Fig. 122). 

8th. bandage for the Su2)erior Border of the Neck. — This 
bandage is a long piece of cloth placed upon the dorsal border 
and lateral faces of the neck, with a prolongation in front, passing 



BANDAGES. 



Ill 




Fig. 119.— Bandage for the Ears, A. Bandage for the MammsB, B. 




Fig. 121. — German Bandage for the Ears. 




Fig. 131.— Another German Bandage lor the Ears. 



112 



SUKGICAL THERAPEUTICS. 




Fig. 123.— Bandage for Superior Border of tbe Neck. 



between the ears and down to tlie forehead. Eight bands secure 
it. The two inferior bands (b) have loops through which the 
bands pass to cross each other under the maxillary bones, and 
extend upward on each side of the head to be tied over the poll. 
The bands (d) are fixed on the breast-band of a Dutch collar, and 
(/) is attached to the surcingle (Fig. 123). 

9th. Bandage for the Anterior and Lateral Parts of the 
Neck. — This bandage is octagonal, with a band at each angle. 
The anterior are tied on the forehead or on the throat-strap of the 




Fig. 124.— Bandage for the Anterior and Lateral Parts of the Neck. 



BANDAGES. 



113 



halter, the middle ones over the dorsal border of the neck; the 
posterior cross each other over the withers, and are secured to the 
surcingle, as are also the two lower (Fig. 124). 

10th. Bandage for the Withers. — This is square, truncated at 
its posterior angles, and having in the middle of its anterior and 
posterior border a fold to adapt it to the height of the withers. 
There are five bands. The anterior are secured forward, above 




Fig. 125.— Bandage for the Withers. 

the breast, the posterior are passed around the thorax and tied 
together, the other sewed on the middle of the posterior border 
extending along the spine and attached to the crupper. 




Fig. 126.— Bandage for the Back. 



114 SURGICAL THERAPEUTICS. 

llth. Bandage for the Back. — This bandage is composed 
of a long, square piece, truncated on its two posterior angles, and 
has six bands, one at each angle. The two in front are tied to- 
gether after passing around the chest, the middle ones after sur- 
rounding the abdomen toward the umbilical region and the pos- 
terior are united after forming a kind of crupper in passing under 
the tail (Fig. 126). 

12th. Bandage for the Loins and Group. — This band- 
age is of a form similar to the preceding, and of sufficient size to 
cover the croup posteriorly. It is truncated on both posterior 
angles, and each border, except the anterior, has folds to allow 
the bands to adapt itself to the rotundity of the region. At each 



Fig. 127.— Bandage for the Loins and Croup. 

angle is a band, the posterior passing around the abdomen, and 
carried backward and upward to be tied over the loins. The pos- 
terior then turns from without inwards, over the round of the hip, 
crossing obHquely the internal face of the thigh forward to the 
stifle, and passing over the external face of the thigh to the mid- 
dle bands on a level with the hip-joint, where they are tied. Two 
extra bands may be attached to the front border and tied to the 
surcingle, if thought necessary, to prevent the bandage from slip- 
ping backwards. 

13th. Bandage for the Hip (Figs. 128, 129).— This is formed of 
a piece of cloth the length exceeding the breadth by one-half, or 
in the proportion of three to two, and so enveloping the hip and 
part of the croup that the inner border runs along the peri- 
nseum, and the outer on the external face of the thigh and leg. 



BANDAGES. 



115 



—Jl 




Fig. 128.— Bandage for the Hip. 




Fig. 129.— The same separate. 

This border (/, d) forms a fold about four inches wide at its base, 
and the inferior {d, e, c) has two which, like the first, form an 
exact adaptation to the parts. Eight bands belong to this band- 
age — three upon the posterior border (a, a, a) at its superior part, 
which are fixed to the cnipper, the superior border having one 
{b) long enough to reach to the sui-cingle, and the inferior border 
having three {d, e, c). The bands d and e pass around the leg 
and cross each other at g, the band d being fixed to the 
crupper, while e extends to the surcingle forward. Band e crosses 
obliquely to the inner face of the thigh, passes upward along the 



116 



SURGICAL THEKAPEUTICS. 



flank, and is tied to the surcingle. The band /is fixed upon e, as 
seen in the illustration, Fig. 128 at h. 

l-ith. Bandage for the Inguinal Region and Perinmum. — 
This is applied to the testicles or to the marnmse. It is a long, 
triangular bandage, with its base placed forward, and is provided 




Fig. 130.— Bandage for tho Inguinal 
Region and Perineum. 



Pig. 131.— Ths same separate. 



with four bands, one at each angle of the base. These are passed 
around the flanks to be fixed on the loins, the two posterior on 
the apex of the triangle to draw along the perineum, and passed 
over, and on each side of the tail, crossing each other to join the 
first one, to which they are tied. 

15th. Bandage for the Abdomen. — This should be oblong in 
shape, its length double its breadth, and having folds on each of 
its long sides to adapt it to the convexity of the body. The bands 
are six in number, two of which are fixed on the loins, two on the 
back, and two over the withers. A seventh is sometimes added, 
which passes around the base of the neck and prevents the band- 
age from slipping backwards (Fig. 132). 

16th. Bandage for the Chest. — This is square, with a prolon- 
gation in front to go between the fore legs, and which is notched 
on the front to adapt itself to the chest behind the elbows. The 
bands are six, one at each angle, and two on the prolongation in 
front. These are fixed in pairs, over the back, the loins and the 
withers (Fig. 133). 



BANDAGES 




Fig. 132— Bandage for the Abdomen. 




Fig. 134 — Bandage for the Breast. 



118 



SUBGICAL THERAPEUTICS. 



17th. Bandage^ for the Breast. — This resembles the preced- 
ing, except that the narrow prolongation is attached under the 
chest to the surcingle, or, surrounding the forearm, goes to the 
withers. The others are tied over the withers and on the sides 
of the chest to the surcingle (Fig. 134). 

18th. Bandage for the Shoidder. — This is cut in the form of 
a trapezium, to cover the shoulder and the arm. It is applied some- 
what obHquely, and has on its front borders (Fig. 135) folds to 
adapt it to the convexity of the anterior part of the arm. Of its 




Fig. 135.— Bandage for the Shoulder. 




Fig. 136.— Same, isolated. 



BANDAGES. 



119 



seven bands, c, c are fixed on the withers at the origin of the neck, 
ef, passing first around the forearm and joining c c, as it passes 
on the opposite side^ and d, g, h are secured to the surcingle. 

19th. Bandage for the Shoulder Joint. — This bandage is 
square and truncated on its superior angle, and is provided with 
several folds to adapt it to the convexity of the shoulder. The 




Fig. 137.— Bandage for th" Shoulder JoiBt Proper. 

bands are six, three anterior and thi-ee posterior. The first two 
are appHed around the neck, the third on a ring at the surcingle ; 
the other three also going to the surcingle, either directly or in 
passing around the inside of the forearm. 

20th. Bandage for the JElhov). — This bandage is of an ir- 
regular shape, with folds on its lateral and lower borders, to adapt 




Fig. 138.— Bandage for the Elhow. 



120 



SUKGICAL THEEAPEUTICS. 




Fig. 139.— Same, isolated. 

it accurately to the point of the elbow. Five bands serve to con- 
fine it, / going directly to the withers where it is tied with i, pre- 
viously passed under and around the thorax on the opposite side, 
g and h are secured to the breast-band of a Dutch collar, k jjasses 
around the forearm on the inside, from behind forward, and 
passes in front of the breast to be also secured to the Dutch coUar. 
21st. Bandage for the Forearm. — This is of an irregular tri- 
angular sharp, with the apex truncated, and the base notched to 
accommodate itself to the axilla and the fold of the elbow. When 
applied, the apex of the triangular, which forms a short border, 
is turned downward and the base upward in the axilla. Two 
bands sewed to each angle of the base are fixed to the breast-band 




Fig. 140.— Bandage for the Forearm. 



BANDAGES. 



121 



of the Dutch collar, and the borders are secured by little tapes on 
the outside of the forearm. Sometimes these borders are fastened 
together by laces inserted obliquely. 

22d. Bandage for the Knee. — This is square, notched on its 
superior border and in the center, both of which are provided with 
a small piece to form a gusset, in which the bony projections of 
the knee are secured. A double, ordinary band, or, what is better, 
an elastic strap attaches it to the breast-band, while smaller tapes 
serve to tie it to the back of the knee. 




Fig. 141 — Bandage for the Knee. 




mm I 

Fig. 142.— Bandage for the Stifle. 



23d. Bandage for the Stifle. — This is of a triangular figure, 
the base of which should be four times longer than its height. It 
has three bands, one at each angle. That of the superior angle 
passes along the flank, and is attached to the crupper strap at the 
loins ; that of the inferior angle twists forward and inward on the 
thigh, and connects with the crupjDcr at the base of the tail, while 
the third band turns around the crupper, crosses the internal face 
of the thigh from behind forward, j)asses in front of the stifle, and 
terminates backAvard at the same point with the preceding band, 
after twisting around that of the superior angle. 



122 



SURGICAL THERAPEUTICS. 



24th. Leg Bandage. — This is the comjDhcated device repre- 
sented in Figs. 143 and 144. It has four bands on its superior 
border, (Fig. 144 «, J, c, d) and the lateral borders have five or 
six tapes. The bandage has three gussets, two of which, c 




Pig. 143.— 



for the Leg Applied. 



and d, are on the superior border, and one, ?*, on the inferior, and 
the two lateral borders have each one a fold. To put the bandage 
in place, the band d is passed along the flank upward and tied to 
the crupper strap, c, passing from within outward on the inside 




Fig. 144.— The same, isolated. 



BANDAGES. 



123 



of the thigh, to be fixed on the round of the crupper. A and b 
cross each other at the lower part of the leg, a Uttle above the 
tendo-Achilles, in order to allow a to pass from the inside to the 
outside of the leg so as to become attached to the surcingle, 
while b is seciu'ed to the round of the crupper. The small tapes 
are, of course, tied together in couples. 

25th. Bandage for the Hock and Cannon. — This requires a 
piece of cloth of sufficient dimensions to completely surround the 
hock and cannon down to the fetlock. Its superior border is 




Pig. 145.— Bandage for the Hock 
and Cannon, applied. 




Fig. 146.— The same, isolated. 



notched for the fold of the hock, and a gusset is made in its lower 
extremity for the fetlock. Four straps j)roceed from its superior 
border to be seciu'ed to the bandage of the leg, and the ends of 
the small tapes of its lateral borders are tied together in pairs in 
front of the leg. 

{g) Mechanical Bandages. — This is the distinctive name of a 
class of dressings which are not only a passive means of protec- 
tion to the parts upon which they are apphed, but from which 
also proceeds a direct or positive action, by co-operating in the 
recovery of lesions, if indeed it is not the true operating 
cause which brings it about. Rollers and wide bandages some- 



124 STJKGICAL THERAPEUTICS. 

times act as mechanical bandages. But the name is more par- 
ticularly appHcable to certain more or less complicated apparatus- 
es, whose special mechanical action has the effect of producing 
some defined therapeutical result. The metallic plate used ia the 
reduction of some forms of hernia ; the metallic spring apparatus 
used in applying pressure upon special regions, as, in orthopedic 
surgery, or in the reduction of fractures or dislocations, like those 
invented by Bourgelat, Brogniez, Defays, and others, are of this 
class, inasmuch as all of these possess the constituent properties 
which are understood to characterize the agencies belonging to 
the category of mechanical bandages. 

These will be subjects for our consideration when we treat of 
the various conditions in which they are iudicated. 



CHAPTER IV. 
ELEMENTARY OPERATIONS. 

Under this term are understood those of a simple nature, as 
perhaps an incision or puncture, or the insertion of sutures, and 
other impHcated manipulations, but which form the foundation 
and belong to the operative generalities of the domain of major 
surgery. They will be treated under the two principal heads of 
division or dieresis, and reunion or synthesis. 

DIVISION. 

This is a very common sui-gical step, of which the object is 
the separation of tissues from each other. Gourdon has recog- 
nized six principal modes by which to divide tissues, viz.: by in- 
cision, dissection, puncture, resection, ligature and cauterization. 
Varying, somewhat, from this view, and considering resection as 
an operation specially appropriate to bony structures, and liga- 
ture as adapted to the cellular tissues, and classifying cauteriza- 
tion as principally a means of puncture, we prefer, with Peuch 
and Toussaint, to reduce the consideration of these modes of 
division to three, viz.: incision, dissection and puncture. 

A. — Incisions. 
Any methodic division of soft tissues made with a sharp 
instrument is an incision. The basis of the majority of surgical 
operations, their purpose is to allow the escape of the contained 
fluid from a cavity, to enlarge the size of a wound, to make 
counter openings, to extract foreign bodies, to remove pathologi- 
cal growths, to destroy abnormal adhesions, to expose tissues to 
be operated upon or tumors to be removed, to facilitate the re- 
duction of displaced organs, etc., etc. The bistoiiry, the scalpel, 
the sage knife and the scissors are the cutting instruments most 
commonly used for making incisions. Sometimes, however, the 
amputation knife, the tenotome, the hemiotome, with lancets, or 



126 



ELEMENTARY OPERATIONS. 



even drawing knives, take their place. Drawing knives, however, 
are better adapted to excise the horny, or other similar hard struc- 
tures, than to cut upon soft tissues. 




Fig. 147.— Straight Bistoury. 




Fig. 148.— Convex Bistoury. 




Fig. 149.— Concave Bistoury. 



Fig. 150.— Blunt Bistoury. 




Fig. 151.— Bistoury Cach6 (Castrating Knife for Females). 

In form, the bistoury is either straight, convex or concave, 
and usually is pointed, but the use of blunt or guarded instru- 
ments is often indicated. The Ustoury cache is also employed in 
some special operations. A bistoury is generally mounted with 
a single blade, though sometimes several blades are moimted 
together on one handle, and can be closed upon it in the 
manner of an ordinary pocket knife. Bat when strict antiseptic 



INCISIONS. 



127 



rules are observed in the operations, the blade is held firmly on 
the handle, and cannot be closed. 

Sage knives, which are much used in operations upon the foot, 
are but convex bistouries, single or double, curved upon their 
length, and, according to the disposition of the cutting edge, are 
called right, or left, or double. The blade is generally firmly 



Fig. 152.— Right, Left and Double Sage Knives. 

riveted in the handle, to render it more soUd and better adapted 
to the incision of the comparatively harder tissues . When made 
to close as an ordinary pocket knife they are less solid, and more 
difficult to keep in good condition. 

The scissors vary also in shaj)e, and are sometimes straight, 
sometimes cui'ved, and with either blunt or pointed ends. Be- 
sides these cutting instruments, directors are often used as guides 
to caiTy the knife in the desii'ed direction, and obviate errors 
and accidents in operating. The bistoury is held in different 



128 



ELEMENTARY OPERATIONS. 




Fig. 153.— Various Shapes of Scissors. 

positions, according to circumstances, as we shall proceed to point 
out and classify. 

1st. Held as a writing pen. — That is, with the handle resting 
on the back of the hand, the thumb, index and medius finger on 
each side of the blade, the other two fingers resting on the skin. 





Figs. 154 and 155.— Bistoury held as a Writing Pen. 
In this position the edge of the blade may be turned either down- 
ward or upward. The division mentioned by Gourdon, with the 
fingers extended or flexed upon the blade is scarcely, and at best 
but a variety. 

2d. The instrument may be held as the hoto of a violin, or 
the thumb on one side of the articulation of the blade, with the 
handle and aU the fingers on the opposite side, the index on the 
back of the blade, the medius on the articulation opposite the 
thumb and the other two fingers on the side of the handle. 
None of the fingers must be allowed to divert the instrument from 
being carried horizontally upon the tissues. In this jDOsition the 
edge of the blade may be turned either downward or upward. 



INCISIONS. 



129 




Figs. 156, 157, 157a.— BiBtoury held as a Bow of a Violin, 

3d. The bistoury can be held as a table knife. The thumb 
and the medius being placed on opposite sides, at the junction of 
the blade and the handle, the index resting upon the back of the 




Figs. 158, 159.— Bistoury held as a Tatole Knife. 

blade, the other fingers holding the handle in the hollow of the 
hand. As in the preceding positions, the edges of the blade may 
be either turned downward or upward. 

Whatever position may be given to the instrument, it is to be 
held firmly, and with a steady hand. Sage knives are generally 
held by grasping the handle full in the hand, or, as when holding 
a bistoury as a table knife, sometimes with one hand only, and at 
others with both, according to the indications and the amount of 
firmness and steadiness required. The manner of holding 
scissors is already known. The only variation likely to be found 



130 



ELEMENTARY OPERATIONS. 




Fig. 160.— Sage Knife held with One Hand, 




Pig. 161.— Sage Knife held with Two Hands. 

needful, is that in some cases it is handier to grasp them from 
above and in others from below. 

There are some general rules which are important to observe 
in performing the simplest operation. These relate to the condi- 
tion of the instrument, to the preparation of the parts, and to the 
direction and dimensions of the incision. 

The condition of the instrument must be such that the soft 
tissues may be divided with but little pressure. It must cut and 
not tear. Therefore, besides their state of thorough cleanliness, 
they must be very sharp and their edge entirely smooth and free 
of indentation, which would cause them to act as a saw and pro- 
duce an irregular and ragged incision, more painful to the patient, 
and more difficult to heal. It has been recommended to dip them 
before using in oil or warm water, but these precautions can be 
dispensed with. 

The region upon which the incision is to be made must be 
thoroughly cleaned, the hairs being chpped short, and sometimes 
even shaved. In these days of antisepsy, it is proper to soak it 
well, after it is washed, with some antiseptic solution. To make a 
clean incision, the skin must be well stretched with the hands, the 
insti-ument firmly held, and the division made by a steady move- 



INCISIONS. 131 

ment, to avoid the possibility of extending the incision beyond the 
necessary limits. 

The dii'ection and size of incisions require careful consider- 
ation. They must run as nearly parallel with the direction of the 
muscular fibres and the large blood vessels and nerves of the 
region as the condition of the part vnU. permit. 

Their direction should also correspond to that of the long 
axis of the part or tumor undergoing operation, and in such a 
manner that the retraction of the skin will not tend to separate 
the borders of the wound. Sometimes, according to the unavoid- 
able natural motions occurring in a region, the normal folds of 
the skin should be considered. A vertical incision is always pre- 
ferable, as more readily allowing the escape of liquids, pus or 
otherwise, which may have accumulated. 

As much as possible, and generally, incisions should be made 
with a single stroke, and of the full length and depth required by 
the further steps of the operation. Besides diminishing the suf- 
fering of the animal, such an incision will greatly facilitate all 
the subsequent manipulations of the operator. 

Incisions are made by four principal methods : first from 
without inwards; second, from within outwards; third by sub- 
cutaneous division; and fourth by the sHcing, scraping or shaving 
method. In the first two modes the instrument may be turned 
in five directions. 

(a) Towards the operator, by beginning at the farthest point 
aud moving the instrument in the direction of his own person. 

(b) From the operator, by reversing the former movement. 

(c) From left to right and transversely, the instrument being 
held with the right hand. 

{d) From right to left, or in the opposite direction, with the 
instrument in the left hand. 

(e) From above doionwards, in a vertical or slightly obHque 
direction. 

Incisions from left to right and from above downwards are the 
most convenient, and for this reason the surgeon practices them 
as much as possible. 

1st. Iiicisions from without inwards. — These incisions are 
carried from the siu-face of the skin towards the deep structures 
underneath. They may be made with any kind of bistoury, but 
the convex is to be preferred. 



132 ELEMENTARY OPEEATIONS. 

The skin should be well stretched by various movements of 
the hand, or of the operator, or his assistants, and held 
tense and smooth, unless it is already sufficiently expanded 
by the effect of the existiag lesion underneath it. Then the 
operator, holding the instrument in the first or third position, 
carries the instrument, with the edges and the point turned down- 
ward, to the spot on the surface to be divided, and penetrating 
thi'ough the skin to the depth desired, completes the incision to 
its proper length. 

This mode of incising the skin answers for the majority of 
cases, but there are others when the skin has to be divided care- 
fully and by layers. Incisions are then made with the convex 
bistoury, held in either position with its edge downward, carried 
perpendicularly over the skin and often by repeated light strokes. 

These two procediu'es answer when the part to be operated 
upon offers a certain soHdity. Otherwise the incision can be 
made in a third manner, viz.: by taking hold of a fold of the skin, 
held at one end by an assistant, at the other by the operator, and 
completing it by a transverse section through the fold, made 
from the apex to the base. The objection to this mode of dividing 
is that the incision can never be thoroughly limited. 

2d. Incisions from within outwards. — In contrast with those 
already considered, these incisions are made from the deep parts 
toward the superficial, and through the thickness of the skin. 

The Straight Bistoury is here the preferable instrument, either 
alone or assisted by a guide or conductor, which may be the grooved 
probe, the director, or the finger of the surgeon. Either with 
or without, these incisions can be executed in various ways. 

Without the Director. — With the bistoury held as a writing 
jDen, with the blade turned upward, first the point of the instru- 
ment, and then the entire blade is thrust perpendicularly through 
the tissues ; then lowering the handle of the instrument untU it 
forms with the skin an angle of forty-five degrees, the instru- 
ment is moved in an obHque direction in such a way as to stretch 
and divide the skin, until at the end of the incision the bistourj' is 
brought back to a perpendicular direction to complete the incis- 
ion in a neat manner. This incision can be made toward or from 
the operator, according to the case. It will facilitate the action 
of the instrument if the skin back of the hand that holds it is 
stretched with the free hand of the operator. 



INCISIONS. 133 

Another manner of incision from' within outward is to make a 
fold of the skin, as ab-eady described, and by pushing the straight 
bistoury through its base, and turning the edge, completing it by 
a single stroke upward to the summit. When an incision already 
existing must be enlarged, the bistoury, held in the second posi- 
tion, is introduced flatwise under the skin as far as is necessary ; 
then turned to bring the edge upward and pushing the point 
through the skin by drawing the instrument outward, the flap of 
skin between the two openings is divided at one stroke. 

A fourth procedure is known as the incision with flaps. It is 
principally used in amputations. With the left hand the surgeon 
grasps a fold of skin, pushes the bistoury held in the first position, 
but flatwise, through its base, and in drawing it out obliquely 
by a sawing motion cuts out a semi-circular flap of the required 
dimensions. 

With the Director or Guide. — Incisions in this mode are made 
to remove compressions caused by strictures, or to establish a free 
exist to jDus by a counter opening. Either the finger or the 
grooved probe or the director may be used as a guide to the in- 
strument. In all cases there must already exist a natiu-al or acci- 
dental oj)ening to allow the introduction of the dii*ector. Several 
modes of procedure are employed according to conditions and ob- 
jects in view. In one, the director being introduced into the tract 
to be enlarged, as far as the point where the incision must end, 
the bistoury, held in the first or second position, mth the edge 
turned upward, is made to slide into the groove of the director, 
forming with it an acute angle, and pushed in its whole length, 
di\'iding the tissues until it reaches the end of the groove, when 
it is withdrawn in the perpendicular position. A second mode 
is to carry the bistoury flatwise alongside the director, and when 
reaching its end to turn the instrument with the edge upward, 
first thrusting the point through the tissues and tegument, and 
completing the incision by withdrawing the bistoury outward and 
toward the operator. In a third procedure, which is that of mak- 
ing counter openings, the probe or director is introduced into the 
wound, and at its deep end, to push toward the skin until it raises 
it from the inside or can be felt through it ; an incision from with- 
out inward is then made at that point, and the director being ex- 
posed, the bistoury is engaged in its groove and pushed alongside, 
dividing the tissues at will in length and in depth, and establishing 



134 ELEMENTAEY OPEKATION8. 

a broad communication between the original opening and the one 
just formed. By using the sharp end of an S probe, passing it 
alongside the director previously engaged, and pushing it through 
the side, the making of the incision from without inward may be 
avoided, as described above, and the groove of the S probe may be 
used as that of an ordinary director. 

Sometimes, however, when the original opening allows it, the 
finser is introduced into it and used as a conductor. In this case, 
a blunt bistoury is preferable, as less dangerous to the operator 
than the straight instrument, or the curved form may be used. 
This may be made to slide with the back of its blade, or again 
flatwise, along the palmar face of the finger untH the bottom of 
the wound has been reached, and then turning the knife, the tis- 
sues are divided by carrying the bistoury either toward or from 




Fig. 162.— Using the Finger as a Director. 

the operator. This procedure is more appHcable when the fistu- 
lous head is not deep, but it is preferable to the use of the ordin- 
ary du-ector as being a much better instrument of diagnosis, and 
safer as a director of the bistoury. 

3d. Subcutaneous Incisions. — The usefulness of this mode of 
dividing tissues is best demonstrated by its apj)lication to cases 
of tenotomy and myotomy, or the puncture preceding the injec- 
tion of tincture of iodine according to some methods. It requires 
special instruments, made with narrow blades or with fine trocars, 
which, when introduced through the skin, leave a very small open- 
ing, the division being made under the ligaments, with special care 
to avoid its division beyond the point where the instrument has 
been introduced. Suppuration seldom follows this operation if it 
has been properly performed, and, accordingly, the cicatrization is 
very rapid ; the great advantage obtained by this mode of incision 
cannot be overlooked. 



INCISIONS. 135 

4tli. Incisions by Slices — Scraping or Shaving Incisions. — 
These incisions are made by di^dding the tissues in successive lay- 
ers. Three varieties of operation are practiced, differing accord- 
ing to the density of the tissues acted upon. In the first, which is 
apphcable to hard structures, the bistoury, or, preferably, the sage 
knife is required. The instrument is held full in the hand, as a 
table knife, or, again, as the bow of a violin, and is passed flatwise 
over the siu*face of the tissues, and layers of various thicknesses 
removed from it ; and sometimes the tissues are sufficiently hard 
to require the strength of both hands for the management of the 
instrument. 




Fig. 163.— Sharp Tenaculum. 

In a second mode, apphcable to soft tissues, a convex bistoury 
and a pair of forceps or a sharp tenaculum are necessary. Rais- 
ing with either of these a thin layer of the tissue to be divided, 
the bistoury is carried sHghtly flatwise over the surface and a piece 
of it is cut, scraped, or shaved off, the operation being repeated 
untn the desired depth has been reached. 

A third mode is applied in cases of growths which are to be 
cut oflf at their base. To do this, the growth is raised as much as 
possible, by means of the forceps or tenaculum, and the amputation 
is accomphshed with a few sawing movements of the instrument. 

The forms which incisions may receive are of two principal 
kinds — the simple and the compound. 

Simple incisions are those which are generally made with one 
stroke of the bistoury, and generally from without inward, 
and are either straight or curved. The straight, or simple, are 
indicated for the exposure of regions, the opening of abscesses, 
etc., etc. They are not as apphcable to the removal of tumors, 
especially of those which have large bases. The curved incisions 
vary in their circular shape, and differ also from the straight in 
the modus operandi, as they require a stretching of the skin to 
be made in various directions, as that of the bistoury is changed 
over the cutaneous surface. 

Compound incisions are formed by the union of several simple 
incisions, their number varying much, but they may be reduced 



136 ELEMENTAEY OPERATIONS. 

to the following kinds: the T and V shaped, the crucial, the 
eUiptic, and the semi-lunar. The branches of these compound in- 
cisions are made in the same manner as for the simple kind ; when 
two incisions are to meet at a given point, the second one must be 
made, not to begin, but to terminate at that point ; when two 
incisions are to unite, one above the other, the lower one is to be 
made first, to avoid the flow of blood from the upper, which would 
cover and conceal it ; and when two incisions are to meet at their 
extremities, it is proper that the ends of the second incision should 
start a short distance beyond the commencing point of the first, 
and terminate with a similar space from the end of the first in- 
cision. In other words, the junction of the extremities of the two 
incisions must never be by a perfect acute angle. The angle must 
always have a shght prolongation formed at one extremity, by the 
extension of one, and at the other by that of the other incision. 
These rules are not absolute, but may be changed as circumstances 
may require. 

In the T-shaped incision, a straight cut is carried perpendicu- 
larly upon the middle of another. In the V-shaped, there are 
two straight incisions meeting at an acute angle by one of their 
extremities, this angle, as we have just said, having a small pro- 
longation on one of its lines at their junction. The V-shaped in- 
cision may open in every direction. Sometimes the two incisions 
are made to meet at a right angle, to form the L-shaped incision. 

In the crucial incision, two straight cuts are made to meet at 
their middle, usually at a right, sometimes at an acute angle, 
forming an X-shaped incision. This is made in three steps, first, 
a simj)le straight cut ; second, the first part of the second incision 
as in the T-shaped form, and third, the second part of the second 
incision ending, not beginning, at the point of junction of the in- 
cision made in the first two steps, and in such a manner as to be 
the continuation of the incision made on the second step. This 
incision may also be made in two cuts, when the skin is hard and 
adherent to the deeper tissues, by making the second incision 
with one stroke of the knife, passing at the middle of the first. 

The elliptic incision is made with two curved cuts, so united at 
their extremities as to leave between them an elliptical space. The 
semi lunar or crescentic incision is formed by two curved ones, 
the circumferences of which are turned in the same direction, 
leaving between them a form like that of the new moon. 



INCISIONS. 



137 



Fig. 164.— T-shape Incision. 




Fig. 165.— V-Bhape Incision. 



Fig. 166.— Crucial Incision. 




Fig. 167.— Semi-Lunar Incision. 



Fig. 168.— ]j-shape Incision. 




Fig. 169.— X-shape Incision. 



Fig. 170.— Elliptic Incision. 



B. — Dissections. 

Dissection is the separation of the cellular tissue from the 
various parts to which it is united. The scalpel, the bistoury 
and the scissors are among the necessary instruments, sometimes 
replaced or assisted by the fingers or a strong director. With the 
scalpel, or the bistoury, the handle is also utilized, and frequently 
the blunt extremity of the scissors, while again in some cases the 
cellular connections are separated with the fingers or the blunt 
end of a director. To these instruments are added forceps, either 
the common dissecting, or the bull-dog form. Three procedures 
are involved, viz.: the free dissection, the limited, and the dissee 
tion by slices or shavings. 



138 



ELEMENTAKY OPEKATIONS. 




Fig. 171.— Dissecting Forceps. 




Fig. 172.— Bull-Dog Forceps. 

(a) Free dissection is that of a flap of skin from the tissues 
beneath, to which it is only sUghtly adherent. Holding the skin 
with the fingers, or the forceps, with one hand, and having the 
bistoury or scalpel in the other, the skin is raised as much as 
possible and separated from the other tissues with a single stroke 
of the bistoury, held as a pen or as a violin bow, the operator 
di-awing it towards him as much as possible. In the dissections 
of flaps of skin, as those in theV, the T, the crucial, and the cres- 
centic incisions, the strokes of the bistoviry extend in length as 
they approach the base, or the adherent portion of the cutaneous 
flap. In the straight or elHptic incisions, on the contrary, the 
strokes are longer at the beginning. When the cellular tissue is 
very loose, its separation from the skin is made with the fingers 
or the blunt end of the scissors. This mode, called enucleation, 
is often employed for some special forms of tumors, as the 
fibroid, or fatty. 

(J) Limited Dissection. — The steps of this process are the same 
as those of the preceding, excepting that the surgeon proceeds 
by small strokes in order to avoid going too deeply into the 
tissues, and leave the skin of a sufficient thickness. 

(c) Dissection by Slices or Shavings. — The skin being divided, 
and the subcutaneous tissues raised with the forceps, the bistoury, 
held flatwise, excises horizontally each layer of the structure by 
a sawing movement. 

C. PUNCTUBE. 

Properly speaking, this is a simple, special operation, designed 
to penetrate into hollow parts, to explore the nature of tumors, to 



DISSECTIONS. 



139 



examine the contents of natural cavities, or to provide for the escajoe 
of gases or flviids. It is, therefore, a solution of continuity of 
small dimensions, constituting often the first steps of an incision, 
but which forms also an essential operation. It can be performed 
with various instruments, as the lancet, the straight bistoury, the 
trocar, the exploring needle and their adjuncts, the aspirator, and 
the actual cautery. 




■ 



Fig. 173.— Various Shapes of Lancets. 

Puncture with the Lancet. — In form and shape the lancet 
greatly varies, but in general it may be considered as a compound 
bistovuy, with a pointed and two-edged blade. The point may be 
either quite wide, or very acute, and is sometimes curved, with one 
edge convex and the other concave. 

To use the lancet, the blade, open at a right angle with its 
handle, is held between the thumb and index finger, while the 





Fig. 174.— Manner of holding a Lancet. 



140 ELEMENTARY OPERATIONS. 

handle rests on the back of the hand, with the fingers shghtly 
flexed. The joint, brought close to the skin, and perpendicular to 
it, is thrust by the extension of the fingers through the tegument 
and tissues underneath and then drawn out perpendiciilarly, un- 
less it is desirable to increase the size of the incision, when the 
division is made by extending the incision from within outward. 
Puncture with the Straight Bistoury. — The bistoury, for this 
purpose, must be finely pointed and sharp. Held as a writing pen, 
with its edge upward or downward, or as a table-knife, accord- 
ing to the thickness of the tissues, and its action limited by having 
the fingers at a given distance from the point, it is pushed per- 
pendicvdarly and more or less raj)idly at once to the necessary 
depth. It is then drawn out, unless the incision is to be 
enlarged, which is done by a motion from within outward 
by the blade. Sometimes the instrument is pushed into the 
tissues in an oblique, instead of a perpendicular direction, when it 
is not desirable to have communication between the opening of 
the skin and the one directly beneath it. This constitutes the first 
step of the subcutaneous incision. 




Fig. 175.— Trocar and Canula. 

Puncture with the Trocar. — This instrument is composed 
of two parts. A rod, secured to a firm handle at one extremity 
and terminating at the other in a tri-f aced point, is one ; this rod 
fits into a canula, blunt at one end and having at the other a cup- 
shaped flange, which is the other part. The canula is long enough 
to receive the entire length of the rod, except the tri-faced point, 
which projects beyond it. The two parts are fitted closely 
together. 

Trocars are of various size and form, being both straight and 
curved. That which is used for hyovertebrotomy is the longest of 
all ; those used for rumenotomy are quite large in diameter ; the 
enterotome is, on the contrary, quite small. 



DISSECTIONS. 



141 




Fig. 176. — Various FormB of Trocare. 



To puncture with the trocar, the operator will assure himself 
that it is in good condition, and that the rod can readily be with- 
drawn from the canula when necessary. Holding the instrument 
in such a manner that the handle, grasped by the three fingers, 
rests in the palm of the hand, the thumb is apphed on the canula 
near its point of union mth the handle, and the index extended on 
the outside of it, to limit the play of the instrument ; the trocar is 
pushed through the tissues in a perpendicular direction, and until 
a sensation of resistance is no longer felt. When introduced, the 
canula is held in place with one hand, while with the other the 
rod is slowly drawn straight out, or by a sHght rotary motion. 

If the design of the operation has been the evacuation of the 
liquid contents of a tumor, as the fluid escapes the growth dimin- 
ishes, and it becomes necessary to insert the caniila fiirther in the 
cavity or turn it in different directions, to ensure the removal of the 
entire contents. Yet it is necessary to be careful not to press the 
orifice of the canula against the walls of the sac, a condition likely 
to prevent the escape of the fluid. 

To remove the canula, moderate pressure is ajDplied with one 
hand on the skin around the seat of the puncture, while the other 



142 ELEMENTARY OPERATIONS. 

withdraws the instrument by its pavilion, drawing it in a line 
parallel to the division in which it was introduced. 

Exploring needles, or trocars, which are but smaU directors 
with a lanceolate blade at one end, and a small groove on one 
side, are also used for making punctures, and their adaptation as 




Fig. 177.— Exploring Needles. 

very small trocars, with aspirators (principally that of Dieulafoy) 
find frequent use in our surgery. These instruments have akeady 
been considered in the chapter upon surgical diagnosis. 

The Puncture with the Actual Cautery. — The conical cautery 
is the one used in this mode of operation. It varies in diameter 
and in length. The instrument is heated to a white heat, applied 
perpendicularly upon the sldn and pushed in until the sense of 
resistance is no longer felt, when it is withdrawn. The condition 
of white heat of the instrument is of great importance. Though 
apparently an act of great severity, the operation finds numerous 
appHcations in our surgical practice, principally for the punctiu'e 
of deep-seated cold abscesses. It has great advantages over the 
puncture with the bistoury, inasmuch as there is no hemorrhage 
to fear from its use ; because the opening made by the cautery 
remains unclosed a longer time, and because the inflammation is 
modified in its nature, and the process of resolution thus assisted 
by the caloric thrown in. 

The use of local anesthesia, by the injections of cocaine, will 
remove from this mode of puncture the rough side of its applica- 
tion by rendering the operation entirely painless. 

KEUNION. 

This term signifies the readjustment and consoUdation of tis- 
sues which had been disintegrated and divided — otherwise, simply 
the reuniting of separated parts, and their restoration to a nor- 
mal condition. This process is otherwise referred to as that of 
cicatrization, a natural property of organic tissues, which, though 
it may be aided and guided by the surgeon, can be controlled by 



REUNION. 143 

him only to the extent of preventing accidents and maintaining 
natural conditions. The processes, the order, and the rapidity of 
the formation of cicatrization are not the same with different tis- 
sues, and certain distinctive terms have therefore been adopted 
by which to denote the modified ways by which the purpose of 
nature is effected. Thus we have immediate reunion or adhesive 
inflammation or union by the first intention, by which separated 
parts soUdify upon simple contact, as varying from union by the 
second intention, or by granulation and suppuration ; followed by 
union by the third intention, when, together with the processes of 
the second intention, there is added one of mortification and the 
elimination of dead structure. This subdivision accords strictly 
with the order of nature, as it may be constantly observed, the 
phenomena of separation involving a regular gradation of de- 
tail in the active forces employed in the recuperative effort, from 
the simplest and most efl&cient in the union by first intention to 
that which is, in fact, a struggle between the elements of growth 
and preservation and the tendency to dissolution and death, as ex- 
hibited in the third degree. 

Before proceeding to the direct discussion of the means used 
to assist the vis conservatrix in the reunion of di\aded parts, there 
are some general considerations of which the surgeon must never 
lose sight. They are not of the less importance because they are 
matters of an obvious and secondary character, and refer mainly to 
what may be termed matters of minor detail. Where immediate 
reunion is looked for, the wound must be fresh and clean, and 
entirely free from clots of blood or foreign substances. The edges 
must be smooth and even, and if there are any ragged portions 
they must be carefully excised. In addition to this, where there 
is a granulating sui-face the gran^dations must be carefully inspect- 
ed and their healthiness assured, and the surgeon must search care- 
fully to ascertain that there are no fistulous tracts present. In any 
case the hair must be clipped short around the edges, the skin thor- 
oughly washed, and, what is a point of primary importance, the 
exact coaptation of the opposite edges carefully ascertained and 
secured. 

The means employed to maintain the contact of the edges of a 
wound, and assist in its closure are, according to Gourdon, of 
four kinds — jyosition, uniting bandages, adhesive plasters and 
sutures. 



144 ELEMENTARY OPERATIONS. 

A. — Position. 

This is more a preparatory step toward obtaining reunion than 
a true means of securing it, and to have its full effect and assure 
all its benefits, must be accompanied by the judicious appHcation 
of plasters or bandages. By position is understood such an atti- 
tude of the patient as will tend to keep in coaptation the sides of 
the wound, as opposed to a posture which would, if left unguard- 
ed, disturb the immobihty which is indispensable to the comple- 
tion of a symmetrical union. The natural restlessness of the pa- 
tient under the cii'cumstances, even irrespective of the ordinary 
UabiUty to the sHghter causes which divert his attention and ren- 
der immobility impossible, forbid the idea of entire passivity. And 
yet there are some cases where it is possible, or at least must 
be attempted. This may be illustrated by the hypothetical case 
of a lacerated wound, forming a V shaj)ed flap of skin, with its 
base turned upward. By taking advantage of this condition, and 
keeping the apex of the V downward, the position of the flap will 
itself assist in closing the wound, the edges having a natural ten- 
dency, from the contractive character of the fibres, to form, and to 
maintain the desirable contact. But if, on the contrary, the flap 
has its base turned downward, the difficulty of keeping it in its 
proper position will be greater, proportionately to the tendency of 
the edges of the flap to drop away from those of the skin. Taking 
advantage of the position of this peculiar wound, and assisting it 
by the apj)lication of bandages or other means, will materially 
facilitate the closure of the wound. 

B. — Uniting Bandages. 

Though these are not so frequently required in veterinary as 
in human surgery, they are very effective in bringing together and 
retaining the edges of wounds, especially in the extremities, where 
in both transverse and longitudinal wounds they fulfil their pur- 
pose very satisfactorily, especially where only the skin is involved. 
If the injury extends to the muscular substance, however, they 
are both more difficult to apply, and less serviceable in their ef- 
fects. In wounds of a transverse character, two bandages of a 
length equal to that of the injured leg, and as wide as the great 
axis of the wound, are required. One of these is divided into 



UNITING BANDAGES. 



145 




Fig. 178.— Bandage for Transversal Wound. 

three or four strips in one-half of its length, the other having in 
its middle an equal number of longitudinal shts, smaller than 
those of the first, these two being fixed parallel to the axis of the 
leg, one above the other below the wound, by several turns of 
roUers, and by passing the strips of one through the correspond- 
ing shts of the other, the edges of the wound will, by opposite 
traction upon the bandages, be necessarily brought together and 
supported in that position (Fig. 178.) 

The same method answers for longitudinal wounds, though 
simpler in structure ; this bandage, consisting of a single band of a 
width equal to the length of the wound, and prepared with strips 
and corresponding shts, as just described, at a distance of about 
three-quarters of the circumference of the leg. Thus prepared, and 
compressive pads placed on each side of the wound, the bandage 
is manipulated as in the other cases, and when it is all properly 
adjusted, is further secured by roUing it around the leg over the 
strips (Fig. 179.) 

C. — Adhesive Sticking or Agglutinating Plasters. 

These descriptive terms refer either to certain special mixtures 
which are applied either directly, and alone upon the solutions of 
continuity, or spread upon hnen, in the form of the ordinary 



146 ELEMENTARY OPERATIONS. 




Fig. 179. — Bandage for Longitudinal Wounds. 

surgeon's plasters. They are better adapted for use, with the 
smaller, than with the larger animals, answering all the require- 
ments with the former class. They are composed of various in- 
ingredients, differently combined, such as black pitch, with resin, 
Venice turpentine, etc., and oils, to improve their flexibihty, and 
aid their curative qualities. 

Venice turpentine, alone, is sometimes spread over the bandages, 
also a mixture of tar and Burgundy pitch. Pitch, alone, when 
melted and mixed with cut oakum or tow, forms a good adhesive 
mixture. The ordinary adhesive, or diachyton, or lead plaster, 
used in human medicine, is of great value in the surgery of small 
animals, and we have used it with great satisfaction with both 
large and small patients, applying it in long strips, roUing them 
around the affected region in two or three thicknesses. Collodion 
has also been highly recommended. Either alone, or applied with 
thin Unen, or what is better, with wadding, it forms over the sur- 
face of a wound, not only an adhesive plaster, but also a jprotec- 
tive dressing. Plasters are, in some cases, used alone as means of 
reunion, and in the treatment of fractures, they form a jDOwerful 
adjunct in controlling the displacements of fragments of bone. 
They are, however, also frequently used to reinforce other means 
of reunion, and especially deep sutures. 

D. — Sutures. 
In all the category of surgical detail, there is nothing so effec- 
tive, or indeed iudispensable, as the suture, properly applied, for 



SUTURES. 147 

the retention of breaches of continuity, whether the sewing be 
done by means of Hnen or silk thread, animal fibre, metallic wire, 
needles, pins or other instruments. By no other means can the 
parts be held in the necessary coaptation to insure a perfect 
reunion. The suture is available for various purposes. Besides 
contributing materially to the coaptation of the edges of a wound, 
and thus aiding to secure a cicatrization by first intention, it pre- 
vents the contact and introduction of air into a wound, arrests 
and prevents hemorrhage, keeps in place lacerated fragments of 
deep wounds which could not be controlled by bandages alone, 
assists in the closure of artificial openings, such as may take place 
in the walls of the abdominal cavity, and prevents the escape of 
any portion of its contents, and assists in the closing of natural 
openings. But, though principally useful in efi'ecting the objects 
enumerated, the essential indication of the suture appears in the re- 
union of solutions of continviity, and, particvilarly, in regions where 
the natural movements of the parts tend necessarily to prevent 
the borders of the wound from remaining in undisturbed contact, 
for a period sufficient to obviate the danger of serious blemishes 
of cicatrization. But while the suture is of no less advantage in 
fresh injuries, it is also indicated as well in suppurating wounds, 
with the precaution of leaving room for the free escape of patho- 
logical secretions. 

Sutui-es are contra-indicated, when a wound becomes the seat 
of extensive inflammation, or occupies a broad surface, or is ir- 
regular, or accompanied by loss of tissue ; or when the parts are 
the seat of severe contusion, or contain foreign bodies or mortified 
tissues in their depths. There are other cases also, where their 
emplo}Tnent is contra-indicated, as when their object is likely to 
be defeated by the uncontrollable movements of the patient. 
Causes of failure may also sometimes be found in the irritation 
arising from the material of which the suture is formed, cutting 
its way loose. By this accident, a wound which, if not interfered 
with, would have left but little if any cicatrix, and would have 
required but a short time to heal, becomes transformed into a 
large, ugly, granulating surface, that is likely to leave a compara- 
tively bad looking cicatrix in the end. 

The appHcation of these retentive stitches falls under the 
general rules relating to the disjyosUion of the edges of the too und, 
and the special placing of sutures. In reference to the first point, 



148 ELEMENTARY 0PEKATIC3. 

the first consideration to be noted is, that the vvoand must, of 
course, be thoroughly cleaned, and free from blood or foreign 
bodies. Then the borders of the wound must be fresh, or, if old, 
blackish, or beginning to granulate, must be slightly excised by 
thin scraping, and the edges brought as closely in contact as 
posaible. 

To apply the suture, the needle is to be held and used precisely 
like an ordinary eewing needle. If the skin is thick enough to require 
it, a thimble can be used. Sometimes special needles with handles 
are made, and sometimes forceps may be needed to grasp the 
needle, and push or pull it through the integument. The needle 
should pass through the skin as nearly perpendicularly as possible, 
since, if introduced too obliquely, the tractions upon the skin may 
be sufi&ciently uneven to involve the possibihty of tearing out the 
stitch. In placing the suture, nerves, tendons and blood vessels 
must, of course, be avoided. The suture should embrace a good 
hold of the skin to secure a greater traction and better approxi- 
mation of the parts ; the distance between the stitches must be 
such that no gaping can take place ; they must be disposed at 
regular distances apart. When the needle is introduced from 
without inward, the skin is raised with the fingers of the left 
hand, or, better, with a forceps ; if introduced from within out- 
ward, pressure is to be made upon the skin with the fingers or 
the blunt blade of a pair of scissors, near the point of exit of the 
needle. 

Generally, the suture is begun at the middle of the wound, in 
which case the edges are made to meet more accurately and regu 
larly. This rule, however, will find numerous exceptions. All 
the stitches should be placed before any are tied, and they must 
be tied only sufficiently tight to keep the edges together; other- 
wise they may cut through the skin. If not sufficiently tight the 
wound will be left gaj)ing and cicatrization will be interfered with. 
The knots ought to be placed as much as j)Ossible on one side of 
the wound and towards the most dependent part, to avoid their 
being soiled by the suppuration. 

The material used for sutures varies much. Strong Hnen 
thread, sUk, metallic wires of silver, lead or tin, and in some cases 
narrow and thin elastic cords or bands are used, according to the 
circumstances. MetaUic wires have the advantage of being less 
irritating, and can remain in the thickness of tissues without giv- 



SUTURES. 



149 



ing rise to excessive inflammation or ulceration if the swelling 
should be extreme. Elastic cords or bands have an important 
advantage in their property of yielding to the inflammatory swell- 
ing, as it develops itself while avoiding dangerous or unnecessary 
traction. 




Fig. IbO.— Various Sutured Needles. 

Suture needles are made in countless forms and numbers, 
straight and curved, and of different lengths and dimensions, but 
having, all of them, flat points. When metallic sutvires are used, 
their extremity is grooved to receive the wu'e in such a manner 
that its double thickness will not interfere with its passage 
through the skin. 



150 



ELEMENTARY OPERATIONS. 





Some needles are armed and protected with handles, as those 
of Trelat, of Riverdin, and of Simpson. Sometimes their lanceo- 
lated part has the eye pierced in its center ; in others, the eye is 
merely a notch, closed by a repulsor, moved by sHding through 
the handle. Generally, the hand is sufficient to push the needle 
through the skin, but at times, as has been mentioned, forceps or 
needle-holders are necessary, such as the needle-holder of Mat- 
thieu, an ordinary forceps or an ordinary pin-holder. The com- 
mon wire dressing pin is also included among suture implements. 



SIMPLE OR INTERRUPTED SUTURE. 



151 




Fig. 186- - Suture Forcops. 




Fig. 187.— Needle or Pin Holder. 



but is not always efficient from lack of rigidity, when a stronger 
and less flexible implement becomes necessary. 

Sutures are of many kinds, some being superficial, others deep, 
and otherwise classified, according to the requirements of their 
application, into single, as when the thread or wire alone main- 
tains the reunion, or compound^ when it requires other and acces- 
sory means, such as needles, pins, quills, etc., etc. 

1. The simple or interrupted suture (Fig. 188) is formed of dis- 
tinct stitches between the borders of the wound, each being tied 



152 



ELEMENTABY OPEEATIONS. 




Fig. 188.— Simple or Interrupted 
Suture. 




Fig. 189.— Looped Suture. 



separately. It is made in two ways. By a first procedure, with a 
needle holding a long thread, the surgeon holding both edges of 
the wound, passes it through both at once, cutting the thread and 
making each stitch entirely distinct, and tying then only when 
they are all in place. He begins with the center stitch. 

In the second procedure, a separate thread is prepared for 
each stitch, having a needle at each end, which is passed through 
the skin from within outward, and, as before, each stitch is tied 
independently of the others. Often, only a single needle is used, 
making the first half of the stitch from without inward, and the 
second half from within outward. 

This suture is used for recent wounds, and those in which 
there is extensive laceration of the integument. 

2. Looped Suture (Fig. 189). — This is an interruj)ted suture, 
in which the threads, instead of being tied up separately over the 
wound, are twisted together on each side, without being tied, in 
order that each thread may be removed independently of the others, 
if necessary. The cords are then twisted together, and sometunes 
tied and sometimes not. 

It was formerly recommended for intestinal wounds, and is but 
Httle used at the present time. 

3. Uninterrupted oi' Glover's Suture (Fig. 190). — This is a con- 
tinuous suture, of which the stitches successively cross the wound 
from both within and without. In making it, the thread is knot- 
ted at the end, and the needle pushed through the skin at one ex- 
tremity of one of the borders of the wound, from without inward, 
and then directly opposite it through the other edge, brought to 



DOSSILED SUTURE. 



153 



the first in crossing the wounds obliquely, and this is repeated 
until the lower end of the edge, opposite to that at Avhich the 
suture was begun, is reached, when the thread is stopped by a 
knot. Before securing the last stitch, care must be taken to re- 
move any possible wrinkles between the stitches. 





Fig. 190.— Glover's Suture. 



Fig. 191.— Dossiled Suture. 



4. Dossiled Suture (Fig. 191). — This is a variety of interrupted 
sutiure, in which the thread is doubled, and at one end carries a 
httle ball or dossil of hut or oakum. Passed through one edge 
of the wound from without inward, it is brought outside of the 
wound, and cut the necessary length. Another similar thread is 
passed through the other border in a similar way, and, when cut, 
both threads are tied together in the center of the wound. 

This suture is often used for the pui-jDose of holding in place 
the substances (wadding, oakum, etc.) that may be placed in the 
wound, or to prevent the return of a hemorrhage. It is a strong 
adjuvant of other hemostatic measures. 

5. Quilled Suture (Fig. 192). — This is formed by a series of in- 
terrupted stitches, supported on each side by a short piece of quill 
or wood, or metaUic jDin, which must be longer than the great axis 





Fig. 192 QuillPd Suture. 



Fig. 193.— Suture with Adhesive Bandage. 



154 ELEMENTAKY OPEKATIONS. 

of the wound. To apj)ly it, a double thread, with the ends knot- 
ted, is passed through the edges of the wound, and several stitches 
made in succession, as in the regular simple interrupted Buture. 
When these are in place, the support (quill, pencil or otherwise) is 
passed through the lap of each double thread on one side of the 
wound. Drawing this first quill close to the skin, the threads are 
separated, and, between them, a second quill apphed on the other 
border of the wound, and secured in place by a knot. 

This suture is recommended for wounds of the abdomen. Peuch 
and Toussaint recommend it after the removal of mammary tumors 
in bitches. Sometimes elastic cords are used, in preference to or- 
dinary threads, as being less putrescible, and yielding better to the 
inflammatory swelling, etc. 

Director Degive frequently employs the elastic suture toitH ad- 
hesive bandages (Fig. 193). 

Two adhesive bandages, of dimensions proportionate to that 
of the wound, are glued on each side of it. These carry near the 
border, in the neighborhood of the edges of the wound, small 
holes, through which elastic rings are passed. These rings repre- 
sent the threads used in the other mode of procedure, and through 
these rings the quills or pins are placed, which will rest on the 
outside of the bandages and keep them in j)lace. 

6. The single pin suture is a simple opera- 
tion for small wounds, commonly used as the 
last step of the operation of bleeding, and by 
which both edges of the wound are brought 
riG. 194.— Single Pin together with a pin, and secured by a special 
Suture. double loop or hitch called the bleeding knot. 

7. Twisted Suture (Figs. 195, 196). — This is frequently used 
for wounds of the eyelids or of the nostrils. It consists in placing 
through the borders of the wound as many pins as may be neces- 
sary, and holding them by twists of thread. Ordinary pins are 
generally used in veterinary surgery. 

The pins are secured in difi"erent ways. In one case, the tvsdsts 
are so made as to form a series of figure 8s, placing them two or 
three times successively, first around the pin at one extremity of 
the wound and repeating the movement with each pin. In an- 
other way, instead of making a figure 8, the threads are turned 
around the pins at each stitch, surrounding all with a circular 
thread. 




ZIGZAG SUTUEE. 



155 





Fig. 195.— Twisted Suture. 



Fig. 196.— Another. 



Some veterinarians, in making this compound pin suture, prefer 
tlie use of elastic rings to that of the circular or figure 8 threads. 
We have personally used these rings with very satisfactory 
results. 

8. Zigzag Suture (Fig. 197). — This is a continued suture in 
which the thread is made to cross and re-cross from one border of 
the wound to the other. The procedure is as follows: a needle 
carrjdng a long thread is passed through one edge of the wound 
from without inward, and thi'ough the other in a straight dii'ec- 
tion from within outward. Starting with the same thread, a sec- 
ond stitch is taken at some distance from the first, and on the 
same side of the wound on which the first was ended, a second 
stitch is made by passing the needle from without inward, and 
back from within outward, to reach the side of the wound where 
the first stitch was started at an equal distance from it. The re- 
maining stitches are, of covu'se, made in the same manner. 

This suture has been recommended for the treatment of um- 
bnical hernia in soHpeds. 

9. Suture of the Furrier. — This is performed with a needle and 
a long thread, which is alternately passed through the edges of 
the wound from without and from within. It is also a continuous 





Fig. 197.— Zigzag Suture. 



Fig. 198.— Suture of ttie Furrier. 



156 



ELEMENTARY OPERATIONS. 





Fig. 199.— T Suture. 



Fig. 200.— X Suture. 



suture, in wliich the coaptation of the borders of the wound is 
regular and exact. It is principally applicable when the borders 
of the wound have a tendency to overlap each other. 

10. T Suture (Fig. 199). — This is the peculiar stitch used to 
bring together the borders of a T or crucial incision. A thread is 
used with a needle at each end, each of which is passed through 
from without inward, in one of the angles of the T, and brought 
from within outward beyond the transverse incision of the T when 
being unthreaded and laid aside. The suture is completed by 
tying the two ends of the thread together. 

The same suture could be made with a single needle. 

The same procedure is required for the crucial incisions. 

11th. X Suture (Fig. 200). — This suture, which is recommend- 
ed after spaying sows, is made by taking a stitch through both 
edges at once, and carrying the thread obliquely across the wound, 
starting the second stitch on the same border of the wound as the 
first, and finishing in the same manner; the thread is then again 
passed across the wound, and the ends tied together. 

12th. Metallic Sutures. — These do not difier from the sutui'es 
which we have considered, excejDting that metals are used instead 
of thread or silk. They are applied like the others, and secured in 
the same manner, by knots or by twisting their ends together. 

The period for the removal of sutiu^es dejoends upon many 
circumstances, and varies according to the nature of the tissues 
involved, their thickness, and the species of the animals operated 
on. In horses and in dogs, suppuration occurs more raj)idly than 
in ruminants or swine, and on that account the sutiu'es cannot be 
allowed to remain as long, without giving rise to the formation of 
pus. Moreover, in regions where cellular tissues and blood vessels 
are abundant, the pus is usually formed more rapidly than in those 



REMOVAL OF SUTURES. 157 

of the opjDOsite formation, and consequently sutures must be re- 
moved earlier. On general principles they should be taken out by 
the foiu'th or fifth day, or even sooner, if indications of complica- 
tion due to their presence are manifested. 

In removing sutures, it is necessary to proceed cautiously, in 
order to avoid breaking any adhesions that may have been formed. 

As a general rule, but one shoidd be detached at a time, be- 
ginning at the least important point. The threads and needles 
should be cut close to the side opposite to that on which they are 
to be extracted ; they must be carefully cleaned of crusts or dried 
pus and any roughness whatever, and the skin should be carefully 
held down as they are slowly drawn out. If the adhesion seems 
at any points to be too Ught, the sutures must be left in a few 
days longer. The appUcation of adhesive mixtures, or of collodion, 
will strengthen a weak cicatricial tissue. 

When a suture has been applied, as well as when it has just 
been removed, it is sometimes necessary, in order to prevent the 
animal from biting or rubbing the cicatrix, to bring the cradle or 
the side bar into requisition. 



CHAPTER V. 

OPERATIONS ON THE SKIN AND 
CELLULAR TISSUE. 

CAUTERIZATION. 

The theory of the cautery is the irritation and disorganization 
of living tissues, either by the immediate contact of heat or of 
chemical substances, producing an analagous effect on the organ- 
ism. Cauterization is thus of two kinds, the actual and the poten- 
tial^ according to the agent employed in its production. 

Potential cauterization, by reason of the nature of the agents 
employed, as well as of the method of employing them, belongs 
properly to the domain of therapeutics, and we shall therefore pass 
the subject by with a simj)le mention, to give our attention to 
what falls more particularly under the head of operative surgery, 
the actual cautery. 

ACTUAL CAUTERIZATION OR FIRING. 

Firing is one of the most valuable of therapeutic agencies. It 
is also one of the oldest and best known among methods of surgi- 
cal treatment, in both human and veterinary medicine. It was 
practiced and recommended as far back as the times of ColumeUe, 
Absyrtus and Vegetius, when it was in high repute as a remedy 
for articular diseases, sprains and weakness of the loins ; but to- 
wards the 15th century, its popularity waned somewhat, and it 
seemed to have partially lost favor, until the days of Markam and 
Gray in England, and SoUeysel in France, where it regained by 
degrees its former repute. It now holds an established place 
among regular and methodical operations, and is one of the most 
important among our surgical resources, applicable in many 
pathological conditions, and efficacious in most. The following 
long list of ailments and lesions in which it may be indicated is 
given by Bouley. 



ACTUAL CAUTEKIZATION OR FIRING. 159 

(a) Diseases of Joints. — Exostoses around the borders of 
articiilar surfaces ; sprains of ligaments ; dilatations of syno^ial 
bui'sse and indurations of their walls ; dislocations ; true or false 
anchylosis ; deformities of the extremities from excess of work ; 
congenital general weakness, etc. 

(b) Diseases of Hones. — Exostoses; periostosis; callus of 
complete or incomplete fractures ; caries ; necrosis. 

(c) Diseases of Tendons. — Pai'tial lacerations ; chronic swelling 
after tenotomy. 

{d) Diseases of Tendinous Sheaths. — Dilatation ; lacerations ; 
changes ia the structui'e of their walls. 

((?) Diseases of 3Iuseles. — Atrophy; induration; pathological 
changes of structure. 

(/') Diseases of the Cellular Tissues. — Chronic oedematous 
swellings; induration; abscesses; cysts. 

{g) Diseases of the JSTervous Apparatus. — Paralysis; occult 
pains without visible lesions. 

{h) Diseases of the Lymphatic System — Chronic lymphangitis ; 
farcinous cords; pustules or tumors. 

{i) Diseases of Veins. — Chronic phlebitis. 

(J) Diseases of Arteries. — Hemorrhages. 

{k) S2)ecial Diseases. — Carbuncular tumors ; gangrene ; ulcers ; 
fistulas, etc. 

To epitomise and simplify this long recapitulation, we may say 
with Gourdon, that the use of the actual cautery is indicated when 
its characteristic effect as an excitant and tonic is sought for in 
atrophy, or in diseases of joints ; or again, as a modifying factor 
in chronic inflammation ; as a derivative, and as a physical or a 
preventive agent. 

It is contra-indicated in cases where there exists an excess of 
vital irritation, or of inflammatory tendency, until the symptoms 
which attend such a state of the system have more or less sub- 
sided. 

Actual cauterization is divided into the superficial and the 
deep., the former being again subdivided into the mediate and the 
immediate. In the immediate the iron is applied directly to the 
skin, while in the mediate the action is supposed to be modified 
by the interposition of some kind of medium. 

The various modes of actual cauterization, according to Bouley, 
are systematically exliibited in the following table : 



160 



OPEBATIONS ON THE SKIN AND CELLULAR TISSUE. 



SUPEEFICIAL. . 



Immediate . 



Mediate . 



Penetrating . . 



Subcutaneous. 



Transcurrent, in lines. 

On surface, a la Gaulet. 

In points or dots. 

By ignited bodies. 

By heated liquids. 

By radiation or objective. 

By the interposition of 
kid sldn or of a layer 
of lard. 



r Kapid. 

[ Inherent or disorganizing. 



Peuch and Toussaint have added the needle cauterization, and 
firing with the thermo-cautery. 

Overlooking several of these specifications, which are of little or 
no utility, such as the firing with the inter-position of ignited bodies, 
of heated liquids, kid skin, etc., we proceed to consider the 
various prevalent and established modes in daily practice and of 
general utiUty. 

Transcurrent, or Firing in Lines. 

The Cautery. — The instrument used in all these operations, 
while formerly made of difi"erent metals, is now made exclusively of 
iron, for which there are various reasons. It is not only because 
of its cheapness and excellence and the general quahties which 
give it universal precedence in the arts, but for some reasons pe- 
cuUar to the case. Thus, its changes of color when heated, render 
it easy to gauge, proximately, the degree of heat, and it also 
possesses the property of retaining heat longer than many other 
substances. 

The form of the cautery varies greatly. The style most com- 
monly in use resembles a small hatchet, of triangular, prismatic 
shape, thick at its base and with a thin border or edge, sometimes 
convex, sometimes straight, and more or less sharp, according to 
the indication. The handle is, of course, of wood or other non- 
conducting material, and in respect to the weight, reference must 
be had to facility of handling and power of retaining heat. The 



THE CAUTERY. 



161 




Fig. 201.— Various Cauteries. 



lighter ones are usually preferred, not only on account of this 
facility, but as being less liable to produce too pronounced an 
effect. 

Heavy instruments, in consequence of the degree of heat they 
radiate, and their contact with a broader surface of skin, are liable 
to transf orra the firing into the condition of a mere burn. 

The size of the cautery will necessarily be regulated by the ex- 
tent of the region to be treated. The cautery must be perfectly 
smooth, on its surface as well as on its thin edge, and to ascertain 
that this is the case, before they are heated a file should be passed 
over both surfaces, and before being apphed to the skin they 
should be again inspected by the surgeon or an assistant, to be 
assured that the edge is clear and clean, and there is no roughness 
to cause a ragged and uneven line on the skin. 

In heating the cautery, a charcoal fire is much to be preferred 
to that from the blacksmith's forge. The latter soon soils and 
blackens the instrument, while the former is smokeless and every 
way cleaner, besides being portable and always convenient. 

There is no uniform rule to govern the position in which the 
animal must be secured. Wlule there are occasions when he can 
be treated while standing, and kept under control by the simple 
means of restraint, in many, and indeed in a majority of cases, 



162 



OPERATIONS ON THE SKIN AND CELLULAR TISSUE. 



it will be every way advantageous to have tlie patient thrown down 
and secured, in order that the region to be fired may be exposed 
as freely as possible — a point which has already been considered. 

The parts upon which the firing is to be made must be thor- 
oughly cleaned and especially free from scabs or greasy sub- 
stances. The hair is to be chpped short whenever its length and 
thickness are likely to interfere with the action of the instrument ; 
yet the skin must not be shaved, inasmuch as a thin coat of hair 
will always prove rather an assistance than otherwise, in drawing 
the first hnes, by preventing the instrument from sUpping. 

There was a period when animals were fired with a view to 
their alleged ornamentation, without any pretext of necessity aris- 
ing from disease, but simply in conformity to the behest of fash- 
ion (and possibly as a means of the identification of property), but 
this artistic firing for fashion's sake is now altogether discarded, 
and the burned-in shapes of fern leaves, stars, crosses, harps, etc., 



1 ^S\ 









^ — 


- 


- 
















~ 


_ 








--, 


L 







Fig. 202.— Old-fashioned Drawings. 



etc., have made room for firings inflicted for better reasons and 
with more beneficient and valuable results. 

And while the results of these aesthetic and artistic firings 
made for purposes of embellishment were usually ugly, un- 
sightly cicatrices, thickened and hairless, the operations of the 
present time leave as their sequelae but slight and superficial 
marks, which are hardly entitled to rank as blemishes, though in 
this connection must not be included the Prange firing (Fig. 203), 
which, with its pecuHarity, is applied as the ordinary line firing, 
except that the lines are divided in small sections. 

Firing in Hnes must be applied not only upon the diseased 
part, but must extend somewhat beyond it, and the lines must be 
made as nearly as possible parallel with the direction of the hair. 



FIRING IN LINES. 



163 




FIG 204.-VariouB Forms ol Drawing in Firing.' 
-T;;e.ringontUeioin..e tuin. oug.t to.e paraUel to me median Une iasteaa 
of oblique. 



164 OPERATIONS ON THE SKIN AND CELLULAR TISSUE. 

This rule we consider a very important one, althougii it is known 
that European veterinarians, when operating in some special re- 
gions, entirely disregard it, firing in lines running at right angles 
with the direction of the hair, though it is quite obvious that the 
result must be an irregularity in the growth of the hair and a 
wavy appearance, which can be entirely avoided by observing the 
rule we have referred to. 

A glance at Fig. 204 wUl give the reader an idea of the proper 
form for making the drawings and the directions of the lines. 
Not only should the Hnes run parallel with the direction of the 
hair, but it is equally important that there should be no deviation 
in the width of the intervals between the lines. It would be im- 
possible to give exactly the distance which must separate them, 
as this depends upon the thickness of the skin, the condition of 
the patient and the effects to be produced. 

In drawing the lines it must be remembered that they ought 
to be of an even depth their entu^e length, but we do not think 
that this can be easily accomphshed with the instrument having 
the convex edge, while there should be no considerable difficulty 
in effecting it by a steady and uniform manipulation with the 
straight edged iron, and by merely raising the hand at the begin- 
ning of the line and depressing it sUghtly at the end. 

The cautery must never be passed in one hne against the 
growth of the hair, and by always drawing it toward himself the 
operator will avoid injuring the bulbs, and escape the danger of 
causing a subsequent abnormal growth of hair. Nor should the 
cautery be passed twice in succession in the same line. If the in- 
strument should slip out of its track before reaching half its 
length, the line should be abandoned and the next one proceeded 
with. To determine the Hnes correctly, and follow them accu- 
rately by the eye alone, requires a natural aptitude which all do not 
possess. It is an art, however, which, if possible, should be ac- 
qmred, and as weU as when existing naturally, cultivated and im- 
proved, by study and practice. But in the absence of the natural 
faculty, which it is so desirable for the surgeon to possess, resort 
must be had to the obviously reliable expedient of previous mark- 
ing, by which a charcoal mark upon a light-haired, or a chalk mark 
upon a dark animal will obviate all risk of lack of symmetry and 
want of regularity. 

The degree to which the cautery should be heated, as well as 



KULES FOR APPLYING THE CAUTERY. 165 

the manner in which it must be moved on the skin, is to be deter- 
mined by the steps of the operation. In beginning- the markings 
of the firing or the initial dravying, the iron must be of a dark red 
color, just hot enough to burn the thin coat of hair left on the 
skin. By this method, any irregrdarity in the drawing can be re- 
moved and corrected by the passing of a second instrument. 
When the entii'e sui'face has been covered with the initial draw- 
ings, and everything is correct, the heat of the cautery can be 
shghtly and i^rogressively increased as the oj)eration approaches 
the end. The rapidity with which the instrument is moved over 
a line should var}^ inversely to the degree to which it is heated, the 
thickness of the skin, the consistency of the subcutaneous tissues, 
and also the stage of the operation. Generally, the movement of 
the cautery should be accelerated when the heat is greatest, when 
the skin is thin, v/hen the tissues underneath are hard, and when 
the operation is nearly completed. 

Another important rule is not to apply too heavy a pressure 
upon the cautery when moving it over the skin. A sHght pressure 
with a slow movemeat is harmless and even advantageous at the 
beginning of the operation, or when the skin is thick, but it be- 
comes dangerous under the opposite conditions when the heat of 
the cautery is extreme. In such a case a true incision of the skin 
may be the result. Firing is essentially a bloodless operation 
even when severely appHed, but it is only by the carefid observ- 
ance of the above rules that hemorrhage dui'ing actual cauteriza- 
tion can be avoided. Its appearance during the operation is, we 
beUeve, the result of inattention, and caused by too hastily raising 
the heat of the instrument, or more often by excessive pressure 
upon it. 

The observance or neglect of these rules will demonstrate the 
difference between scientific and unscientific firing, and show that 
while one is true sclentijic surgery, the other is simply burning 
the skin. The first is applied by one who appreciates the value 
of the results he hopes to realize, while the other merely places a 
hot iron in contact with the skin, quite ignorant of the good or 
evil results which may f oUow the act. As the operation progresses, 
changes take place upon the lines, which give an indication of the 
strength of the firing. These objective changes consist in a change 
of color in the lines, and an accompanying exudation from the skin. 
In the first degree, or light firing, the Hues are not deep, and 



166 OPERATIONS ON THE SKIN AND CELLULAR TISSUE. 

are of a golden yellow tint, having only a few isolated drops of 
serosity at their sides, the dermis not being extensible, and the 
skin between the Hnes free from infiltration, the epidermis can- 
not yet be scraped with the finger nail. In the second degree or 
ordinary firing, the lines are of a lighter color, or bright yellow, 
the drops of serosity are more abundant, the dermis is more ex- 
tensible, the skin between the lines is thickened with infiltration, 
and the epidermis is easily scraped off. In the third degree, or 
strong firing, the lines have a light yellow color, the dermis is so 
thinned that the slightest traction of the portions between the 
lines, which then become wider, stretches it, the serosity is abund- 
ant and overruns the edges of the lines, and the skin between 
them is infiltrated and possibly covered with small phlyctenases or 
bUsters. To proceed fiirther will be to produce a deep burn, 
which may be followed with serious complications, or at the least, 
leave large, unsightly cicatrices. 

The length of time required to produce these effects, and the 
frequency of the applications upon a given region, are points by 
no means easily determined. They are affected by many contin- 
gencies, which cannot be anticipated. According to Fromage de 
Feugrd, a cautery heated to a cherry color must be used in each 
Hne from ten to twelve times for a light firing, and from fifteen to 
twenty for more serious cases ; but Gourdon considers these fig- 
ures too high, and says that from five to six strokes will be suffi- 
cient for a firing of the first degree, from eight to nine for one of 
the second, and from twelve to fifteen for the third, or strong fir- 
ing. But these figures have no absolute value. The number of 
strokes will depend upon many conditions, such as the heat of the 
instrument, the state of the parts and the dexterity of the operator. 

The effects resulting from actual transcurrent cauterization 
may be divided into primitive and secondarg. 

(a) Primitive effects. — The inflammation which follows the 
burning manifests itself by the appearance of a serous exudation, 
the serosity being in the form of small di-ops, in greater or less 
abundance, according to the degree of the cauterization. This 
serosity collects between and at the bottom of the lines, and con- 
tinues to flow for from twenty-four to forty hours, when it is re- 
placed by the formation of crusts or scabs, dry, yellowish, and ir- 
regular, and if the firing has been light, attached to the bottom or 
the borders of the lines ; but covering the entire cauterized sur- 



PRIMITIVE EFFECTS. 167 

face between tlie lines, as well as at the bottom, if the firing has 
been stronger. These crusts of dry serosity remain adherent for 
a few days only, and from the sixth day to the eighth they begin 
to separate, but the di-opping off of the cauterized j)ortions of the 
skin requires a longer time, varying according to the degree of the 
firing. In the first degree they are ehminated by the formation 
of a new layer of epidermis. It is a process of dry desquamation 
by which they are exfoHated, and requires from two to three 
weeks for its accompHshment. In the second degi-ee, when the 
thickness of the cauterized tissue is greater, the scabs 23i'oper are 
more adherent, and it requii-es a process nearly aUied to one of 
suppurative expulsion, which may consume a month before the final 
sloughing is accomphshed. In the third degree, a regular process 
of suppuration is necessary for the removal of the scabs, and 
its completion will requu-e a period of not less than five or six 
weeks. 

After light firing, the marks left are scarcely detectable ; after 
the second degree, the hair grows over the hues, but in an irregu- 
lar way, giving a somewhat roughened appearance to the part, 
while the strong firing leaves a thick and callous epidermis, and 
therefore a serious cicatrix. Besides these first and dii-ect effects 
of the cautery, there are others which ought not to be overlooked. 
About the parts where the firing has been applied, the skin and 
the subcutaneous tissues become the seat of extensive inflamma- 
tion, accompanied with pain and sweUing, and in some animals 
this may assume a severe aspect. The swelling may extend until 
it involves the entire extremity, and this may seriously interfere 
with the act of locomotion. It, however, subsides and disappears 
as the process of the removal of the scabs advances, and when 
this has been accomphshed, the swelhng and pain will also have 
disappeared. 

(b) Secondary effects. These are slow in their development, 
and cannot be easily or weU described, and they vary widely ac- 
cording to the objects for which the firing has been appUed. It 
may be said, however, on general prmciples, that the development 
of secondary effects cannot be expected except after a consider- 
able lapse of time, allowing at least several months, and in any 
case, only long after the objective effects have entirely disappeared. 

The treatment following the operation, is of a very simple 
character. For a few days, and until the secretion upon the 



168 OPERATIONS OK THE SKIN AND CELLULAR TISSUE. 

cauterized parts has dried and the scabs have begun to slough, 
the animal must be restrained from lying down, and biting or 
rubbing himself, nor must this vigilance be relaxed, until the 
danger of breaking up the surface of the wound has ceased, with 
the temptation which was kept up by the continuation of the irri- 
tation, with the dropping off of the scabs and of the cicatrization. 
There is no necessity for interference with the sloughing of the 
scabs, or occasion for impatience to see them removed. After 
a period of time, which varies according to the severity of the op- 
eration, they will separate spontaneously, or with a little friction 
of the parts, or washing with tepid water and soap. 

A question of some importance in connection with this oper- 
ation, is that which refers to the use of oily or greasy substances 
in the treatment of the cauterized surface. In times past this was 
accounted to be good practice, and soothing embrocations were 
recommended and freely employed, but this treatment has become 
nearly, if not wholly, obsolete. At the most, vesicating prepara- 
tions are considered allowable, but even these only under special 
conditions, as when the cauterization has not been sufficiently 
strong. This practice is specially prevalent in the United States, 
where the operations of firing and blistering are almost always as- 
sociated. This combination has nothing objectionable, and in fact 
is justified by the apprehensions and opposition existing among 
Americans. Yet practitioners must always remember, that if 
many cases where firing is indicated terminate unsatisfactorily, 
after both firing and blistering, it is because the true and local 
effects of the cauterization, by ordinary or strong firing, have not 
been produced, when they were necessary to obtain good results. 
The possibility of ugly cicatrices cannot be well avoided if proper 
firing is to be depended upon. In view of the fact that the effects 
of firing are not limited to those which visibly and immediately 
appear on the surface of the skin, but that others of importance 
are also to be anticipated, after a certain time, the question of the 
duration of the rest necessary for the patient after the firing, be- 
comes one of some importance. 

All written authorities on the subject agree in saying, that 
this rest must be a long one, reckoning it by months, though in 
some instances hght exercise, or even light work, may be allowed 
sooner. Generally speaking, however, the surgeon will be guided 
by the nature and history of his case, and especially by the extent 



SECONDAKY EFFECTS. 169 

of the cauterization. The patient will of course require perma- 
nent and absolute rest for a few days, or until the serosity and 
the scabs have dried, but after that he may be allowed the Uberty 
of a box-stall, or of the pasture, without interfering with the 
necessary oversight of his condition and progress. There are 
cases where moderate walking exercise coiold not be otherwise 
than beneficial in its effect upon the final result. 

Though, as we have said, the aj)j)lication of greasy medica- 
ments may not be recormnended, yet, as a substitute or alterna- 
tive, bhstering ointments may be used to supplement too Hght a 
firing. It is, in fact, not rare to find it necessary to follow the 
firing with a severe bhstering after the scabs of the first operation 
have fallen off. If this is done, however, it must not be until the 
more active effects have diminished, and the inflammation has 
subsided. 

It may sometimes become necessary to solve the problem of 
the duty of the veterinarian in cases where an animal requires the 
treatment of the cautery on two places on one leg, or on two legs, 
or perhaps on the entire four. 

Humane feeUng alone ought to furnish a sufficient guide in 
this matter. "When the operation is not only in itself so excep- 
tionally painftd during its performance, but is followed by further 
suffering arising from the necessity of protecting the animal 
against himself, it should be considered sufficient to inflict the 
firings singly, and after the first infliction to repeat the torture 
only after a respite of several days. On this point we differ from 
the opinion expressed by some European writers, and cannot dis- 
cover the alleged benefit to be derived from any extra dispatch, 
in the absence of any ui'gent reason for considering it to be im- 
perative. Our conviction is strong that one firing ought not to 
foUow another until the immediate effects of the first have sub- 
sided, and the animal has had several days to recuperate from the 
great strain he has been compelled to endure. 

The application of transcurrent cauterization is very often in- 
dicated in sohpeds, and we borrow from Bouley a hst of the ordin- 
ary lesions for which it is most frequently emjDloyed. 

A. — Regions of the Extremities. Coronet. — Indicated against 
ringbones, circular periostitis following phalangeal arthritis, or 
deep penetrating wound of the foot ; exostosis following fractures. 
AppUed in hues, parallel to the axis of the bone ; not too near to- 



170 OPEKATIONS ON THE SKIN AND CELLULAR TISSUE. 

gether, to avoid sloughing of the skin; never fire beyond the 
second degree ; avoid burning the coronary band. Eesults : gen- 
erally efficacious, but necessary to repeat it. 

Fetlock. — Articular or tendinous windgaUs ; exostosis ; perios- 
titis after sprains or arthritis ; induration of tendons ; cold infil- 
trations and indm-ation of cellular tissue; knuckhng. AppUed 
in parallel lines, vertical in front and shghtly obhque behind. Re- 
sults : not so satisfactory, though in many cases favorable. 

Cannon. — Splints ; callous and thick tendons ; cold infiltra- 
tion and induration of ceUular tissue. Applied as in the fetlock. 
Results : generally very satisfactory ; second firing is often re- 
quired. 

Knee. — Articular and tendinous synovial dilatations at any 
part of the joint ; hygroma; bony deposits. Applied in parallel 
Hues, vertical in front or oblique on the lateral faces. Very ad- 
vantageous for synovial dilatations and hygroma ; less so in exos- 
tosis. 

Forearm. — Bony growths of any kind ; muscular weakness, 
manifested by sprang knee. Lines parallel to the axis of the re- 
gion. Beneficial for exostosis ; doubtful in the other cases. 

Elhow-joint. — Bony deposits; dilatation of articular synovial 
sac. In parallel lines. Results very satisfactory. 

Arm. — Weakness of olecranon muscles. In lines parallel to 
the hairs. Results very doubtful. 

Shoulder. — Muscular atrophy ; paralysis ; diseases of the artic- 
ulation, dilatation of the coraco-radialis bursae; lameness of un- 
known nature, and located in that region, may involve the en- 
tire region, or it may only cover the scapulo-humeral angle. In 
the first case, appHed in lines parallel to the direction of the 
hair, extending from the upper to the lower end of the scapula, 
the firing has an oval shape ; in the second case, the firing is 
circular, and forms parts of two parallel Hues, slightly oblique to 
each other. Generally advantageous in atrophy and occult lame- 
ness, doubtful in paralysis, not so much in articular or tendinous 
diseases. 

Hock. — Articular or tendinous tumors, hygroma, dilatation of 
the bursse of the extensors of the cannon and flexors of the foot, 
bony growths, peripheric periostitis, cold infiltrations, and indura- 
tions of cellular tissue. Drawings of the firing at the hock vary, 
according as it may be desired to fire the entire joint or only j)art. 



KEGIONS OF THE BODY. 171 

In this latter case it is applied in vertical or oblique lines, form- 
ing a drawing as regular as possible. In the former case two ways 
are recommended ; in one the siu'face of the hock is divided into 
halves by a line drawn parallel with the tendo- Achilles ; all lines 
back of this one are parallel with it, and all those in front of it 
are parallel with the front of the hock, and therefore slightly 
oblique to the others. In the other method, a line is drawn from 
the point of origin of the tendo-Achilles vertically downward to 
the cannon bone, and upon this, oblique, feather-shaped lines are 
drawn on each side. Results, generally rather favorable in all 
the diseases of the hock. 

Leg. — Bony deposits, rupture of the cord of the flexor meta- 
tarsi; chronic swelling applied in lines parallel to the region. 
Results, very advantageous. 

Stifle. — Dilatation of femoro-patellar bursas, exostosis of the 
patella, luxation, pain remaining after bruises or wounds, liga- 
mentous fistulas of old standing. Applied in several parallel ver- 
tical lines in front, and on each side oblique to them. Results, 
almost always successfiil. 

Thigh and Goxo- femoral Joint. — For similar lesions to those 
of the shoulder, atrophy, paralysis, occult lameness ; same appli- 
cations. Results about the same. 

B. — Regions of the Body. Loins. — Weakness of vertebral 
column due to paralysis ; sprain of the vertebral column, vertebral 
periostitis, occult pains. Applied in lines parallel or oblique to 
the median line of the body. Results generally doubtful. 

'Withers. — Chronic cysts, indurations following fistulous 
withers, old fistulas. A few lines parallel with the vertebral col- 
umn, the others oblique. Results almost always beneficial. 

Rihs. — Acute or chronic pleuresy and pneumonia. In lines 
parallel with the long axis of the ribs ; seldom used, the results 
are difficult to appreciate. Principally used by Nicholson and 
Maclean against contagious pleuro-pneumonia. 

Firing on the Surface, or a la Gaulet. 
This is so named after its inventor. The mode of operation 
is with cauteries which have their border, or the part which is 
apphed to the skin made to form a flat or slightly convex sur- 
face (instead of being thin and sharj)), in order to remedy one 
of the principal objections to ordinary firing, that of lea^4ng 



172 OPEKATIONS ON THE SKIN AND CELLULAR TISSUE. 

permanent marks. It proposes to effect this by throwing upon 
the surface of the skin an even radiation of heat. The descrip- 
tion given by Mr. Gaulet is this: "The iron being heated to 
nearly a cherry color, a straight line is made in the principal 
direction of the region to be fired, and immediately alongside of 
it another, and so successively until the entire surface is covered. 
The first hues are then crossed, transversely or obliquely, by 
others, which perhaps also touch each other, and at last, in order 
to have the entire surface evenly cauterized, the parts which have 
not been touched in tracing the original lines are also touched 
with the iron which then retains but one-half of the heat it pos- 
sessed at first." 

* * * " After twenty-four hours, or perhaps less, an inflamma- 
tory swelling takes place, and the skin is covered with small 
blisters of serosity ; three weeks after, the crusts which have fol- 
lowed begin to drop off, and the hair is seen growing underneath 
them." 

According to Bouley, this method cannot be substituted for 
the ordinary cauterization. If applied lightly, its effects are not 
more severe than those of an ordinary blister ; but if applied in a 
severe form, it is Uable to be followed by the sloughing of large 
portions of skin, and to leave behind cicatrices of the very worst 
description. It has, however, in the hands of Mr. Paul Boviley, 
given satisfactory results in its application upon the stifle, the 
point of the shoulder, and the cyst of the withers, and with Mr. 
Naudin, in the treatment of chronic swellings of the extremities. 

Firing in Superficial Points. 
This form of cauterization is performed with instruments of 
conical or olivar forms (see Fig. 201), having the point blunt and 
rounded, in order to rest on the skin without incising or penetrating 
it. The point must not be so long as to cool off too rapidly, nor 
so short as to be incapable of retaining a sufficient amount of heat. 
In this mode of firing, the points or dots are arranged in quintu- 
ples, a first series of points being marked in either a vertical, 
obhque or horizontal Hne, equidistant from each other, and more 
or less close according to the indications ; a second series is 
marked on a parallel Hne, at a distance equal to that which sepa- 
rates the dots of the first series, and placing the first point on a 
line with the middle of the space separating the dots of the first 



FIEING IN SUPERFICIAL POINTS. 



173 



series, thus alternating the appUcation of the points in a third and 
fourth series, until the whole surface is covered. This makes a 
regular drawing, and leaves but httle blemish afterward. 

The rules pertaining to the appHcation of firing in straight 
lines are the same as in the cauterization in superficial points, and 
they apply to this also, but we beheve this is to be better indicated 
ia the firing of small surfaces, for bony deposits, ringbones, 
splints, spavins and side-bones, or generally in the treatment of 
circumscribed diseases. 




Fig. 205.— Firing in Dots and Points. 



Firing in poiiits is always more eJBfectual than that in straight 
lines, and being exempt from the danger of skin sloughs, it always 
leaves fewer blemishes. Moreover, ia a majority of cases, it can 
be appUed without casting the patient. These are points which 
should count largely in its favor. The principal objection to be 
urged against it is the greater length of time required to realize 
the full measure of its effects. 

Mr. Prange has invented a mode of cauterization, which is very 
similar to that in superficial points, but differing from it in the 
fact that instead of points, the ordinary flat iron is used. 
It is cauterization in Hues, but instead of being long and made 
with one stroke of the cautery, they are divided into short lines 
(see Fig. 203), also arranged in quiatuple, like the dots of the 
poiat firing. This method has not found favor with those who 
have experimented with it. 



174 operations on the skin and cellular tissue. 

Objective Firing, 

In this mode of cauterization, the heat is transmitted, not by 
contact, but by radiation. It is a process rarely resorted to, and 
when it is used it is more as an adjiuict to transcurrent firing, or 
as a simple mode of revulsion. It consists simply in bringing the 
heated iron in close proximity with the surface to be cauterized. 

Gaulet is reported to have obtained good results from it in 
the treatment of ulcers, grease and ophthalmia ; Leblanc in chronic 
diseases of the eye, and Laux in the treatment of chronic lameness 
of the thigh. According to Gourdon, it is indicated for the arrest 
of some internal hemorrhage of mucous membranes ; for the re- 
duction of prolapsus of the rectum and of the uterus ; in hernias ; 
to stimulate the cicatrization of ulcers, and against some chronic 
inflammation of mucous membranes, of the conjunctiva, the pituit- 
ary membrane, etc. 

The cautery used by Mercier is square, oval or circular, with 
the surface, which is to face the skin, unpoHshed, while the other 
is smooth and poHshed, a disposition designed to graduate the 
firing by facilitating the radiation of the heat with the first, and 
diminishing it with the second. 

The special aim in this plan is to avoid the formation of a slough, 
and to attain it as perfectly as possible, the firing ought to be so 
managed, as to approximate the point of disorganization as nearly 
as possible without reaching it. 

In operating, the surgeon, after satisfying himself of the con- 
dition of the skin and its subjacent connections, moves the instru- 
ment to and fro over the part, carefully avoiding contact with the 
tegument. If the hair burns too quickly, it indicates an excess of 
heat, or that the instrument is too near the surface. The heat 
should be gradually increased from a brown to a cherry red color. 
The duration of the operation depends on the condition of the 
skin. When the epidermis can be easily scraped with the finger- 
nail, or is raised by the formation of small bhsters, and the fired 
surface becomes moist, and shows little drops of serosity, and the 
skin becomes thicker, denser, and more adherent to the subjacent 
tissues, the evidence is present that the proper degree of firing has 
been reached. 

The serosity increases immediately after the operation, and 
for some time continues to flow, until the surface is covered with 



OBJECTIVE FIRING. 



176 



its dried pellicles or crusts. On the second or third day an in- 
liaimnatory swelling is developed, and all the symptoms of ordin- 
ary lii-ing are manifested, and after three or four weeks the reso- 
lution is complete. 

If the firing has been too severe, the serous secretion becomes 
very abundant, and the inflammatory sweUing increases rapidly and 
becomes warm and painful. Towards the fifth or sixth day the 
skin becomes black, dries up, shrinks, is raised in large patches, 
and sloughs off, leaving a broad sm^face, covered with large granu- 
lations, very slow to cicatrize. One great advantage which objec- 
tive cauterization can claim o\'er ordinary firing is, that when prop- 
erly performed, it leaves no blemish whatsoever. 

Deep Cauterization. 

The cauterization which is carried beyond the thickness of the 
skin and penetrates the subcutaneous structures, receives this 
designation. 

The manner in which the cautery is inserted into the tissues, 
and the length of time it is allowed to remain in contact with them, 
have justified the division of this kind of cauterization into rapid 
deep^ and inherent, or disorganizing cauterization. 

Rapid Deep Cauterization. 

This is the comparatively recent mode known as needle firing, 
inasmuch as it consists in the insertion of elongated sharp, needle 
shaped cauteries, heated to a Hght red, Urbain Leblanc is credited 
with the introduction of this species of instrument and is the 




FiC. 206.— Abadie Cautery. 



176 



OPERATIONS ON THE SKIN AND CELLULAR TISSUE. 



author of the first report of its results. The first cautery used 
by Abadie resembled the one shown in Fig. 206. In using it, 
the animal is generally secured in the standing position. It is 
applied at a Hght red heat and made to penetrate through all the 
tissues down to the subcutaneous cellular structure, and even 
through the synovial sheaths. Leblanc's advice is to make the 
puncture by passing the iron three or four times in succession in 
the same spot, but Abadie completes it at a single stroke. This 
firing is followed by severe inflammation of the parts, great pain, 
swelling, abundant serous secretion, and the escape of synovial 
fluid. It has, therefore, powerful revulsive effects, which, how- 
ever, leave scarcely any marks, provided only the finest parts of 
the cautery have penetrated the tissues. Otherwise extensive and 
fatal suppurative arthritis may be looked for. This cauterization 
is indicated in cases of exostosis, tendinous swellings, articular and 
tendinous synovial dilatations, splints, riagbones, spavin, side- 
bones, thick tendons, articular and tendinous windgalls, thorough 
pins, blood spavins, etc. 

In the true needle cauterization or ignipuncture, the form of 
the cautery is changed, but in all other respects there is no 
difference. 

The forms of the needle instruments are numerous, and of 
course each one claims some special merit. The cautery of 
Bianchi and that of Foucher were first used, and these were fol- 
lowed by the instruments in which the point or needle of platinum 
could be changed. There were others of more complicated make, 
as those of Bourguet, Salles, Lagarrigue, VasseUn and others, or 




Fig. so?.— Bianchi Cautery, 



RAPID DEEP CAUTERIZATION. 



177 




Fig. 208.— Foucher Cautery. 

of more recent invention the autothermic cautery of Mr. Ehret 
(Fig. 211). 

In using these instruments, whatever may be the position of 
the animal, the perforation is made vsdth a single stroke only, the 
points being from three-fourths of an inch to an inch apart. When 
operating on a synovial bursa, the needle is applied but once ; but 
if the skin is thick and indurated, two or even three times may be 
necessary. The subsequent application of a stiff blister is recom- 
mended by some, immediately after the operation, but by others 
after an interval of a few days. This firing is always accompanied 
by severe inflammation and its usual phenomena, but it generally 
subsides after a few days. 



178 



OPEBATIONS ON THE SKIN AND CELLULAR TISSUE. 





Fig. 209.— Cautery with Changing Points. 

No severe accidents are likely to accompany needle firing. 
Small hemorrhages may occur, but they usually cease spontane- 
ously, though it must be admitted that fatal cases of arthritis 
have been recorded, which, however, are avoidable by the use of 
proper precautions. The attention required by the patient after 
these operations do not vary from those required in ordinary cau- 
terization, although the duration of the period of rest, always 
necessary, may be less prolonged. 



Inhekent Firing. 

This differs from other kinds, in beiug performed with the 
cautery heated to a white heat, with a view to produce more or 
less deep disorganization, according to the needs of the case. 
Sometimes the appUcation is made upon the surface only, but at 
others at a required depth upon the deeper tissues. 



INHERENT FIRING. 



179 




Fig. 2:0.-Bourguet Cautery. Fig. 2n.-Autothermic Cautery. 



180 OPERATIONS ON THE SKIN AND CELLULAR TISSUE. 

In the first instance, it is indicated in superficial cutaneous ulcers, 
in wounds indisposed to cicatrize ; in those following warts, in fun- 
goid growths, in cancerous, melanotic or fibrous tumors, in gan- 
grenous wounds and those following the opening of a cold abscess ; 
in fistula due to caries or necrosis of bones, tendons or ligaments, 
etc. The instruments used are of various shapes : round, 
olivary, annular or cultellar. They are applied firmly upon the 
tissues, and held in place for a few seconds, according to the density 
of the parts If the surface is wider than the instruments, the 
firing must be done by sections, applying the iron in detail upon 
spots, until the entire surface has been touched. This is a better 
method than that of rubbing the instrument over the surface, and 
renders the effect more regular and uniform. In the second 
degree, or the cauterization into the depth of the tissues, a conical 
instrument is used and held in its place of insertion until it has 
lost most of its heat, thus reaching whatever depth may be neces- 
sary. 

This cauterization is indicated against anthracoid, gangrenous, 
farcinous and cancerous tumors ; in wounds of a virulent or veno- 
mous nature; in purulent infiltrations of the skin or of the 
cellular tissue ; in caries of bones, tendons, cartilages and liga- 
ments, in dental caries, in indurated tumors, in fimgoid growths, 
polypoid granulations, etc. Renault has recommended them in 
the treatment of the large sores so often occurring in granular 
dermatitis. 

Subcutaneous Cauteeization, 

Otherwise known as Neapolitan cauterization, or " a la Nan- 
zio," consists in the appUcation of the cautery in points directly 
upon the muscular structure, exposed by an incision made through 
the skin. The method was known and had been mentioned by 
Ruini, SoUeysel, Bourgelat, Reynal and others in more or less 
modified and varying terms, before Mr. de Nanzio called the at- 
tention of the profession to the good results he had obtained by 

it. 

Its application is principally efficacious in the treatment of 
chronic lameness of the shoulder or of the coxo-femoral joint. 
The instruments required are two bistouries, one curved and one 
straight, two flat tenaculums, a buU-dog forceps, scissors and an 
ordinary oHvary cautery. De Nanzio thus describes the oj^era- 



SUBCUTANEOUS CAUTERIZATION. 



181 




Fig. 212. — Cauteries of Nancio. 



tioj : " My method consists in making an incision from above 
downward to the skin covering the articulation, the location of 
which has been first carefully determined. The skin is then dis- 
sected from the cellular tissue, and the flaps enveloped with folds 
of wet cloth. The flat tenaculum placed on each border of the 
incision keeps it open, and mth a blunt cautery, not too red, three 




Fig. 213.— Firing b. la Nancio. 



182 



OPERATIONS ON THE SKIN AND CELLULAR TISSUE. 



or four points are applied upon the seat of the articulation, 
carefully ascertaining with the finger the point which the cau- 
terization has reached, and carefully avoiding the opening of the 
joint." 

The subsequent treatment is simple, and consists in cleanli- 
ness, lotions of clear or slightly astringent water, and the protec- 
tion of the wotmd by small threads of oakum. The suppuration 
is abundant and the wound ugly, but these effects are soon modi- 
fied, and healing is followed by only a simple linear cicatrix. Se- 
vere compHcations have been recorded as sequelae of this operation, 
but, on the other hand, several authors have spoken of it in very 
favorable terms. Our own experience with it has not been suffi- 
cient to warrant the expression of a confident opinion. 

Cauterization with the Thermo-Cautery. 

This valuable instrument, the invention of Doctor Paquelin, 
has only within a comparatively recent period been added defi- 
nitely to the armament of the veterinarian. The original instru- 
ment, as used in human surgery, has been modified by the inven- 
tor, and as now sold by our instrument makers, is fully adapted 




Fig. 214.— Paquelin Cautery. 



CAUTERIZATION WITH THE THERMO CAUTERY. 



183 







Fig. 215.— Paquelin and de Place Cautery. 

to veterinary practice, and possesses points of superiority over 
all the rest. It is used in the same manner and under the same 
rules as other modes of firing already considered, but w^hile its 
application is followed by similar results, it possesses also many 
other attendant advantages, which render it a valuable addition to 
our operative means. 

The veterinary cautery of Paquelin and de Place is a modifica- 
tion which has recently been introduced, and which is considered 
superior to the original instrument by those who have used it, 
principally on account of the facility with which an even degree 
of temperature is kept during the entire length of the operation. 
The low price of the instrument is also an important item for vet- 
erinary practice. 



Cauterization in Other Animals. 

Firing in Large Ruminants. — If firing is not as commonly 
used with these animals as with solipeds, it is not because its ne- 
cessities are less frequent, but rather from economic considera- 



184 OPERATIONS ON THE SKIN AND CELLULAR TISSUE. 

tions, and because when they become seriously disabled, instead 
of subjecting them to expensive surgical treatment, a wise pecu- 
niary policy consigns them to the shambles where they may still 
claim an unimpaired market value ; while a dead horse is (in 
popular estimation, at least) held to be of no particular worth in 
theory, that is, whatever may be the unconscious practice of un- 
inquiring eaters of "beef." 

It has been apphed, however, in very numerous instances, by 
Cruzel, Roche, Lubin, Festal, and especially by Lafosse, who rec- 
ommended its apphcation in articular, muscular and tendinous 
lameness ; for synovial dilatations, bony growths, anchylosis and 
luxations, and also in nervous affections, epilepsy, paraplegia, va- 
rious paralytic cases and amaurosis. 

The modus operandi is the same as that already described 
for solipeds, although allowance must be made for the thickness 
of the skin, which requires a deeper application, and necessitates 
the repetition of the firing from twelve to fifteen times in the 
same line, in order to obtain an ordinary effect. The scabs of the 
firing generally separate in from fifteen to twenty days, and leave 
pale rose wounds, followed by cicatrizations with a smooth sur- 
face. The swelling of the parts, and the reactive fever following 
the operation, is more severe, but subsides quite readily. The 
animal must be prevented from rubbing or hcking himself in 
order to obviate the danger of secondary wounds with their trou- 
blesome comphcations, as with soHpeds. 

In smaller anim,als cauterization is seldom resorted to. In 
dogs, however, its apphcation is sometimes indicated in lameness 
of the elbow, the stifle, and even the hip joints. Superficial firing 
by points has been advantageously apphed, and is recommended 
by Peuch and Toussaint. 

Accidents of Actual Cauterization. 

To a great extent, the accidents and failures following the use 
of the cautery result from the non-observance of the rules estab- 
lished for the regulation of the operation, and subsequent care- 
less and incompetent nursing. The remedy for these is too obvi- 
ous to need mention. 

(«) Section of the Skin. — This is a very common accident, usu- 
ally chargeable to the carelessness or incompetence of the sm*- 



ACCIDENTS OF ACTUAL CAUTERIZATION. 185 

geon, or it may be caused by the use of too heavy or too sharp an 
instrument, or to an excess of heat or of pressure. It is recog- 
nized by the separation of the edges of the wound, and the ap- 
pearance at the bottom of the Hues of a white nacreous stria, 
shown by the subcutaneous tissue. There is no remedy for this 
accident, and though it is not a very severe lesion, it is likely to 
be followed by rough and irregular cicatrices. 

{b) Hemorrhage. — We have said that firing is an essentially 
bloodless operation if properly performed. The appearance, there- 
fore, of drops, or perhaps of a small stream of blood, at the bot- 
tom of the lines or points, and perhaps running over the surface 
of the skin, though unattended with danger and not likely to be 
injurious, is, at the least, evidence of some miscarriage of skill. 
If it arises from the use of a rough or too sharp an instiniment, it 
can be readily suppressed by searing the part, or applying uj)on 
bleeding vessels another cautery, heated a little in excess of the 
first. Sometimes the burning of a smaU quantity of pulverized 
resin, or of a small lock of hau- in the bleeding cavity, will have 
a sufficient hemostatic effect, and simple pressure will seldom, if 
ever, fail. 

(c) Tearing off Scabs. — This is the result of careless and in- 
secure dressing, and in omitting to provide effective safeguards 
for preventing the patient from reaching the wound with his own 
teeth, or rubbing it against some hard object. Suppurating 
wounds of various dimensions are often the result of this inad- 
vertency, requu'ing careful treatment, and sometimes leaving bad 
blemishes to be regretted. 

(d ) JSloughing of the Skin and Subcutaneous Tissues. — This 
accident is not uncommon, and like that just mentioned, is the 
effect of the improper application of the cautery, though less the 
effect of the firing than of burning the parts, and it is character- 
ized by all the conditions of ordinary bum wounds. Among 
specific causes, however, may be mentioned too strong a firing, 
or firing with lines too near together, or touching each other at 
some angle, or in crossing, or when too large an iron is used, or 
one brought to a radiating heat, or too high a temperature; or 
when greasy substances have been applied in the lines, or the skin 
submitted to long frictions. All these causes tend to the disorgan- 
ization of the skin, with mortification and sloughing, and its sej^ara- 
tion in large patches, leaving after healing, broad, ugly blemishes. 



186 OPEEATIONS ON- THE SKIN AND CELLULAR TISSUE. 

(e) Bad cicatrices. — Though firing, however carefully applied, 
will always be followed by legible marks, there are cases in which 
bad, callous cicatrices form a positive and repulsive life-long dis- 
figurement of the animal. In the most aggravated forms of the ac- 
cidents enumerated, there are circumstances which particularly 
favor their occurrence. Among these may be regarded the thin- 
ness and sensitiveness of the skin, the interference of the animal 
himself, by rubbing and biting, and an excessive suppurative 
action accompanying the falling off of the scabs. No treatment 
is known that can be made effective against these lesions, but it 
is satisfactory to know that they do not inhere in the operation, 
and are preventable in the exercise of projDer skill by the operator, 
and attention by the nurse. 

EXUTORIES. 

An executory is any therapeutic agency or means the efi'ect of 
which is to promote the formation of purulent matter, and to 
sustain the suppurative process after it has been established. 
Some exutories have no special intrinsic quahties, and simply 
take effect in the manner characteristic of foreign bodies when 
lodged in any portion of the system ; while, on the other hand, 
some of them possess specific properties by which a special irrita- 
tion is produced in the tissues with which they come in contact. 
The various forms of seton are included in the first class; 
the trochiscus, bhsters, however composed, the moxa, and the 
actual cautery belong to the second. But while the fact of 
the utilization of the operation is as old as the practice of 
medicine itself, the modes of application and the materials used 
have varied considerably during various epochs. The use of the 
root of black hellebore was recommended for diseases of the ears 
in large ruminants, and also in the treatment of diseases of the 
chest, or in oedematous swellings of the abdomen. 

At a later period, the actual cautery found its advocates in 
the treatment of tetanus. The introduction of feathers, or long 
quills under the skin, in the treatment of old shoulder lameness, 
followed, and in some parts of the world this practice has not yet 
been wholly abandoned. Sometimes the feathers were used 
alone, and in other cases air was blown into the cellular tissue 
under the skin, in the parts where they were to be placed. The 



EXTJTORIES. 187 

first description of the seton and its effects was given by Markam, 
in 1556. But even after that date we read of the use of irri- 
tating soft pencils, or candles composed of various ointments, 
melted or mixed together, and introduced under the skin, incised 
for the purpose, and more or less massed or bruised with some 
hard substance. But the accidents which were apt to accompany 
some of these energetic forms of treatment were of so serious 
a nature that they gradually fell into disuse, and to-day this class 
of principal exutories includes only the seton in its various forms, 
the trochiscus and the vesicating preparations. 

Exutories act as counter irritants, resolvents, and alteratives. 
The irritation which follows their contact with the living tissues 
excites the purulent secretions, and the activity in the process of 
interstitial resorption, which they stimulate, render theii' adoption 
and frequent use a source of much benefit and great satisfaction 
to the veterinary practitioner. The list of ailments in which 
their value is manifest and unquestioned is a long one, and com- 
prehends affections of the chest, catarrhal inflammation of the 
air passages,' and affections of the abdominal organs, with those 
of the eye, and in dogs of the ear. They stimulate the resolution 
of local affections having a tendency to chronicity, for example, 
oedematous swellings of the extremities, and they are frequently 
indicated in diseases of the locomotory apparatus, in certain af- 
fections of joints, and in rheumatic lameness, and also to excite 
the resolution of soft tumors, especially those of the synovial 
structures. The most ehgible of the forms in which exutories 
are prepared, especially when they are designed to act as a means 
of drainage, or to prevent the accumulation of pus in anfractuous 
cavities, is the seton. It is recommended in nervous affections 
and in paralysis, and also for the relief of atrophied regions, and, 
according to Bouley, it may often become a means of diagnosis, 
as well as of prognosis. 

In an acute disease having a tendency towards recovery, a 
seton wiU have an irritating effect, and give rise to a phlegmons 
sweUing about its tract, while in the same disease, if the tendency 
be toward a fatal termination, the artificial suppuration which it 
causes will soon cease to flow, and the tract will remain compara- 
tively dry. 

There have been those who have made the seton a prophylac- 
tic agent, or insurance institution, to be made use of at certain 



188 OPERATIONS ON THE SKIN AND CELLULAR TISSUE. 

special periods or seasons of the year, and have thus invented the 
seton of prevention or of precaxdion, but without satisfactorily 
demonstrating what is to be prevented, or what anticipated. The 
theory, if any, in which such an assumption originates cannot be 
certified, and honest veterinarians cannot themselves identify it 
with such a practice or pretext. 

If exutories are a frequent resort, and are highly appreciated 
in veterinary surgery, and their general use is commonly unat- 
tended with danger, yet they are not always so absolutely harm- 
less that they may be trifled with, and prescribed without due 
consideration of the peculiar conditions under which their use is 
contra-indicated. It cannot be rationally supposed that the 
potency to which they owe their beneficial effect when rightly 
directed is to vanish when it is erroneously applied, and that it 
can be made innocuous by misdirecting it. Animals debilitated by 
heavy work or by disease ; those affected with cdironic organic 
ailments; those threatened with eruptive diseases, or suffering 
with septic complaints; none of these are fit subjects for the 
application of exutories. 

SETONS. 

A seton is a form of exutory which consists in the introduction 
of a foreign substance under the skin, ordinarily a band of linen 
tape, or a leather ring. The former is known as the tape seton, 
while the second is more appropriately termed a rowel. 

Tape Seton. 

This is usually merely a piece of clean, white tape, of suitable 
width and length as required by the case. In some circumstances, 
however, cords or braids of lint or horse-hair are substituted. 
The seton may either be introduced under the skin alone and 
dry, or it may be saturated with some irritating fluid, or covered 
with a stimulating ointment, to increase its effect and promote the 
purulent secretion. The operator must not fail to allow a suffi- 
cient length to securely tie the ends which pass out at the two 
openings of the tract through which it is drawn. Yet they are 
not always secured by an ordinary knot, but are quite generally 
united by a species of twist upon their extremities, which can be 
readily loosened when it becomes necessary. This knot must be 
sufficiently wide and strong to prevent it from slipping through 



SETON NEEDLES. 



189 




Fig. 216.— Seton Knots. 

the incision. In some cases, instead of making a knot on the tape, 
small wooden pins are secured at the extremities, and answer the 
same purpose. 

The essential instrument required to apply a seton is the 
peculiar needle known as the seton needle. It is, of coiu'se, made 
various lengths, some consisting of but a single piece (Fig. 218); 




Fig. 218. Fig. 219. Fig. 220. 

SETON NEEDLES. 



Fig. 221. 



190 



OPEBATIONS ON THE SKIN AND CELLULAR TISSUE. 



while others are in two or three sections, connected by screw joints 
(Figs. 219, 220, 221), and in some few instances fitted to handles 
(Fig. 217). But however they may otherwise vary, they are in 
the general form of a stiff, iron rod, with one lanceolated extrem- 
ity, both edges sharp, and a large eye at the blunt end to receive 
the tape. The lanceolated portion is slightly curved on the flat 
side. There are also other forms designed for special objects, 
among which may be mentioned one which is used for passing a 
seton through the frog of the foot, and is therefore known as the 
frog seton-needle. ' 




Fig. 222.— Frog Seton Needle. 

For small animals, such as the dog, the smaller sized straight 
needles are often suitable, and the one which is used for making 
the quiU-suture is very convenient. 

Besides the seton needle proper, in its authorized and usual 
patterns, occasions sometimes occur when to meet special requii'e- 
ments, a straight, pointed bistoury and a pair of scissors are re- 
quired as adjuncts. 




Fig. 223.— Quill Suture Needle. 

The operation of setoning is comparatively a bloodless one, 
and the division of the cellular tissues through which the needle 
passes is very often made without any hemorrhage. Yet there 
are regions where more or less blood may subsequently escape. 
A region, therefore, where the cellular tissue is abundant and 
loose, is that which is most favorable for the introduction of 
setons. 

The modus operandi is simple. The hair must be closely 
clipped from about the points selected for the two preUminary 
punctures, one for the entrance and one for the exit of the needle, 



SETON NEEDLES. 191 

and the patient must be properly secured. Certain nervous ani- 
mals may oblige the siu'geon to place them in the recumbent posi- 
tion, but our experience has taught us that the cases in which this 
is necessary are very exceptional, and that in the great majority 
of operations, the simplest means of restraint, a twitch, with the 
raising and securing of one or two of the extremities, is all that is 
requii-ed. 

The application of local anesthesia, so far as it may be practi- 
cable, is also a measui'e which is in all respects judicious and com- 
mendable. With the spraying apparatus, any part of the body 
can be reached with great facility. 

In introducing the needle, many veterinarians pass it dii'ectly 
thi'ough the skin, which is raised in a fold, and drawn away as far 
as possible from the deeper tissues. This maybe readily practica- 
ble in regions where the cellular tissue is very loose and abundant, 
as under the chest ; but it is much less so, and more dangerous 
where the skin is thick, and the subjacent connective tissue is de- 
ficient or scant, and especially if the edges and point of the 
needle are not perfectly sharp. 

For this reason the method preferred by many is more judi- 
cious, of making an incision with the straight bistoury through 
the skin at each of the two extremities of the proposed tract 
through which it is intended to pass the seton. The manij)ulation 
is sufficiently easy and simple, the operator holding the skin in a 
fold with one hand, while with the other he guides the needle 
under the skin and parallel with it, through the cellular tissue, 
entering through one of the punctui'es made with the bistoury, 
and emerging through the other. The point most important to 
observe here is that of so guiding the needle in its motion that it 
shall neither plunge into the deeper tissues nor emerge outwardly 
at the wrong place. At this point the scissors may be utilized by 
laying blades .flatwise over the place of exit, and pressing down 
the surface. Directions are sometimes given, as the next step, to 
insert the tape into the eye of the needle, but it would seem that 
the safer plan would be to have the tape akeady in place when 
the needle is introduced. After the tape has been drawn through, 
and the needle disengaged, the next and final step is either to 
unite the ends of the seton by a knot, or, without tying, to secure 
them separately by the twisting or plaiting already described, and 
leave them free. 



192 OPERATIONS ON THE SKIN AND CELLULAR TISSUE. 

The first effects following the application of a seton are those 
met with in a majority of ordinary wounds ; more or less swelling 
and inflammation, followed by an access of the suppurative pro- 
cess. At the points of insertion and exit of the needle, a certain 
amount of hemorrhage takes place, generally of no importance, 
and subsiding without interference, and this is succeeded by a 
swelling along the braid of the seton, at first more or less diffusi- 
ble, with a tendency to increase during the first forty-eight hours 
but then becoming more defined. In the beginning, and for the 
first two days, there is a flow of a thin serosity from the opening 
of the seton, which gradually assumes the character of suppura- 
tion of good quality in the shape of creamy, laudable pus. Up to 
this period the seton needs no attention, and should be left with- 
out interference, to exhibit the natural traumatic effect of its 
presence. Although it is desirable to have the suppuration weU 
established and flowing freely, it must not be permitted to accumu- 
late in the tract, and should be subjected once or twice a day to 
gentle pressure along the entire length of the seton, to expel the 
least portion of purulent matter present. At the same time, such a 
pressure as would be Hkely to crush the granulations of the wound 
and thus excite small hemorrhages, must be avoided. 

The cleaning and washing of the openings of the seton, and of 
the tape itself, must be carefully and strictly performed as often 
as the abundance of the discharge requires it. It should be sys- 
tematically attended to, not less than once or twice daily, at the 
least. Precautions must be taken to prevent the animal from 
biting and pulling off the seton, and yet this accident is very 
possible, and it may frequently become necessary to replace it. In 
that case the needle should be introduced by its blunt end, with 
the new tape previously inserted in the eye. At times it becomes 
necessary for other reasons to renew the seton. A feasible way 
to effect this will be to attach the old tape to the new, and draw 
out the former by means of the latter. The length of time a 
seton ought to be allowed to remain in place varies according to 
circumstances, extending to a period of from three to four weeks, 
or even longer. 

When the time has arrived for the discontinuance of a seton, 
if more than one have accomplished their purpose and had the 
desired effect, they ought not to be all removed at the same time, 
but singly, and with an interval between them. Nor must the 



APPLICATION OF TAPE SETONS. 193 

wound be neglected because the seton lias been removed, but it 
must receive needed attention for several days. Tlie openings of 
the tract will still require cleaning, and the residue of the pus will 
still require the aid of pressure to effect the final emptying of the 
wound. 

Tape setons are applied upon all parts of the body, but more 
frequently, of course, in regions where their therapeutic effects are 
most needed, for which reason they will be most commonly 
fovmd on the breast, the ribs, the shoulder, the hip, the thigh, the 
stifle, the abdomen, the neck, the cheeks and the foot. 

(«) The Breast. — This is a very common location for the setons. 
In inserting it the animal is secured in the usual way, but to pre- 
vent his striking the operator with his fore feet it will be necessary 
to have one of his hind legs raised and firmly held. If there is 
but one seton it must be introduced on the median line ; if two, 
one on each side of it. 

The position assumed by the operator varies, according to the 
abiUty he possesses, and the hand with which he operates. If 
ambidexter, and but a single seton is to be introduced, he can 
operate from either side of the animal, and if two are to be insert- 
ed, he can change the needle from one hand to the other, to suit 
his convenience, without change of position. 

This seton is to extend from the anterior extremity of the 
sternum downward and backward, vmder the chest, or between 
the fore legs, backward beyond the elbow. When the incision of 
exit has been made, and the tape introduced into the eye of the 
needle, the instrument must be drawn away in the direction op- 
posite to that in which it was introduced, to avoid the possibility 
of doing injury with the point or the edges. 

(J)) 0)1 the Hibs or the Chest. — Setons are used in these 
regions for the treatment of diseases of the thoracic organs. 
Sometimes as many as three are applied, either on one or both 
sides of the chest. They should be placed in a slightly oblique 
direction from before backward and from above downward, 
beginning about the middle of the side of the thorax, and ex- 
tending as far as the lower border of the chest, occupying, there- 
fore, the lower half of the thoracic cavity. The manner of insert- 
ing the seton in the tract made by an incision with a bistoury 
through a fold of the skin has been already described, and a 
repetition in minute detail becomes unnecessary. 



194 OPERATIONS ON THE SKIN AND CELLULAR TISSUE. 

Care must be taken while operating in this region to avoid 
wounding the spur vein, which can be done by raising the skin 
well from it when the point of the instrument has reached its 
course, by which movement the needle passes outside of the 
vein and can be brought outside on the inferior border of the 
thorax. The tape is thfen placed in the eye of either the needle 
or the blade as already frequently described. Our own practice 
is to secure the tape through the eye of the blade, and draw the 
tape into position by removing the needle from below upward, 
considering this plan to be both more convenient and less dan- 
gerous. 

(c) At the Shoulder. — Setons are often applied in this region 
against lameness of old standing ; at times only one, at others 
two, or even more, according to the extent and location of the dis- 
eased region. When applying more than one, they are commonly 
placed parallel with each other. Many practitioners place them 
crossing each other, meeting in the middle of their length, with 
their point of meeting on a level with the center of the scapulo- 
humeral joint. In placing them, the compound, or three-jointed 
needle, somewhat flexible (already described), will be necessary, 
as beiag capable of adapting itself as much as possible to the 
convexity of the joint. Some care is required in the selection of 
a proper place for the puncture, and the animal must be kept in 
the standing position as much under restraint as possible. 

There is probably no special rule for the location and direction 
in which setons should be apphed, the discretion of the operator, 
in many cases, furnishiag the only guide. This is well illustrated 
in the application of the monstrous "seton a la G-aulet^'' so called 
from its inventor, and which consisted in surrounding the entire 
scapular surface with one immense seton, beginning at the cervical 
angle of the scapula, running along its anterior border to a point 
below the shoulder, passing in front of the breast to the axilla, 
through that region, horizontally back on a level with the elbow, 
to return outward and then upward to the dorsal angle of the 
scapula, where it ended. This form of exutory is no longer toler- 
ated, the dangers attending it, from the severe and exhausting 
drainage of the organism having brought it into discredit, with 
the result of its dismissal from general practice. 

A seton at the shoulder requires special protection from the 
animal, by means of the cradle or the side bars, its location 



APPLICATION OF TAPE SETONS. 195 

makiag it too easily accessible to his teeth to be suffered to re- 
main long in place without such a defence. 

{d) Seton at the Hip-Joint. — Lameness of this region is fre- 
quently treated by the tape seton, the conditions of their appUca- 
tion being nearly identical with those required when the shoulder 
is the region involved. They are placed, whether single or dou- 
ble, directly over the articulation, or crossing each other in the 
X form, and also over the center of the joint ; and care must be 
taken that they are not inserted so obliquely as to interfere with 
the free flow of the pus. A needle similar to that used with the 
shoulder will be found convenient, and for a similar reason, the 
thickness of the skin, and the closeness of its connection with the 
sub-tissues, will render necessary the preliminary incisions with 
the bistoury to facilitate the entrance of the needle ; and the con- 
trol of the animal, as he is to be treated on his feet, should be 
secured by supplementing the restraint of the twitch with that of 
the side Hues, and raising one of the hind legs. 

(e) Setons at the Thigh. — These are prescribed in chronic 
swelling of the hind legs. The region they should cover extends 
from a level with a point a little below the inside of the ischial 
tuberosity to the superior third of the shank, and they should be 
placed in a slightly obHque direction from without inward. It is 
necessary while operating here, as in the hip-joint, to have the 
animal well secured, and not only the twitch and the side-lines, 
but sometimes the raising of one of the fore foot will be required ; 
as of all setons, this is probably the most painful to insert, in con- 
sequence of the division of branches of the sciatic nerves, which 
lie in the course of the needle. The steps of the operation do 
not in any way vary from those in other regions, and therefore do 
not call for a redescription excepting perhaps to specify that in 
placing the tape the convexity of the blade must be turned in- 
wardly, and an assistant will be needed to hold the tail aside. The 
tying of the tail to the surcingle on the opposite side of the body 
will prevent its becoming soiled with the discharge of the seton, 
and render the subsequent care of the patient easier. 

{f) Setons at the Stifle. — This seton is recommended by Peuch 
and Toussaint in lameness of that region which has resisted vesi- 
cating liniments and blistering applications. They recommend 
the recumbent position for the safety of the operator. A convex 
bistoury and the ordinary seton-needle are required. The animal 



196 OPEBATIONS ON THE SKIN AND CELLULAR TISSUE. 

while lying down has his hind leg extended by the traction made 
upon it by assistants with a rope. An incision is made above 
with the bistoury, and the needle introduced through it, it is 
pushed downward in front of the joint, carefully raising the skin 
as it progresses, to avoid injury of the femoro-patellar articulation. 

{g) Seton on the Abdomen. — This seton is both difficult and 
dangerous to apply in the standing position, and, therefore, unless 
the animal is very carefully secured, and the operator unusually 
dexterous, it is better to have the animal cast. The seton placed 
on the median line, under the abdomen, extends from about the 
xyphoid cartilage back to near the sheath or other mammae. In 
applying it, care must be taken to avoid injury to the tunica abdom- 
inahs and the abdominal muscles, or making a deep wound of 
the abdomen. Caution must also be exercised against the possi- 
bility of the animal kicking against the needle at the moment of 
its passage through the skin at the opening of exit The tape 
when introduced in the eye of the instrument is to be drawn into 
the tract by puUing the needle away from behind forward. 

(A) Setons to the Neck. — These are recommended against im- 
mobihty and periodic ophthalmia. They are placed in an obhque 
direction, one or two, on one or both sides of the neck. The hori- 
zontal direction sometimes recommended is certainly quite un- 
likely to facilitate the free escape of pus. In introducing the 
needle it is better to direct it from below upward, starting at 
about the level of the convexity of the mastoido-humeralis muscle. 

(^■) Setons on the Cheeks. — These have been more or less ad- 
vised in the treatment of diseases of the eyes, and principally of 
periodic ophthalmia. They are placed a little below the zygomat- 
ic spine, below and in front of the temi^oro-maxHlary articulation, 
and extend downward some distance in front of the zygomatic 
crest. The blood vessels of that region, and principally the large 
nerves which cover the masseter muscles, must be carefuUy avoid- 
ed, to guard against paralysis of the lip. 

{j) Setons in the Foot. — The insertion of a seton in the foot, 
or i\ie frog-seton, as it is also called, has been principally recom- 
mended in the treatment of navicular disease, though it is con- 
sidered by many as of very doubtful utility. A special curved 
needle (see Fig. 222) is used for the purpose. The horse is in 
some instances kept in the standing position, while in some special 
cases it is better to have him thrown. 



KOWEL SETON. 



197 



The shoe being removed, and the sole and frog pared down 
and made as thin as possible, either an incision may be made 
in the hollow of the heels, or the needle inserted without it 
through the skin, in such a direction as to have its point emerge 
at about the front part of the middle commissure of the frog. 
The tape is drawn into position by pulling the instrument straight 
away through the opening of exit. The seton is to be secured by 
tying ends together. When the operation is performed while the 
animal is standing, a strong assistant must hold the foot, and the 
needle pushed and passed through the frog rapidly, as by possible 
struggles, severe injuries of the tissues of the posterior part of 
the foot might result. 

KowEL Seton. 

This form of exutory is of earher origin than the ordinary tape 
seton, and consists in a round piece of leather, felt or pasteboard , 
sometimes perforated in its center, which is deposited in a pouch 





Fig. 224.— Rowel Seton. 

made under the skin, either simple, or sometimes surrounded 
with a band of tape to prolong its continuance. It is piincipaUy 
used when the disposition of the parts renders the introduction of 
a tape seton diflficult, or when it is for any reason contra-indicated, 
and especially when the exutory being indispensable to the well 
being of the patient, it is at the same time imperatively required 
that the animal shall be preserved free from any blemish or dis- 
figurement. It is also to be preferred with animals which cannot 
be prevented from tearing out the ordinary tape seton with their 
teeth. 

A pau' of scissors and a straight bistoury are required for its 
insertion. A simple incision is made with the bistoury, long enough 



198 OPEBATIONS ON THE SKIN AND CELLULAR TISSUE. 

to allow the introduction of the rowel, rolled or doubled on itself ; 
then, with the scissors passed flatwise under the skin, a pouch is 
made, by dividing the cellular tissues, of sufficient dimensions to 
secure the rowel, which is to be opened or unrolled and flattened 
in the pouch in such a manner as to bring its central opening in 
correspondence with the incision in the skin. 

This form of seton can remain for a period of from fifteen to 
twenty days, and there are cases where it has been kept in place 
as long as six weeks. It can easily be removed with the forceps 
or a pointed tenaculum. 

Trochiscus. 

This is an exutory formed of some mineral or vegetable sub- 
stance, sometimes termed an issue pea, possessed of irritating or 
even caustic properties, which are introduced imder the skin in the 
same manner as the rowel. They differ from the other exutories 
by causing a greater amount of irritation, a higher degree of in- 
flammation, and for that reason are left in place for a shorter 
period, and are removed as soon as inflammatory symptoms are 
well estabUshed. They are less frequently used in solipeds, but 
are of more common employment in cattle. In the former, how- 
ever, lameness of long standing in the upper segments of the legs 
has been successfully relieved by them. In cattle they are often 
inserted in the dewlap. They can be introduced directly under 
the skin, either through an incision made alone, or attached to a 
seton, which may continue longer in place after the removal of the 
trochiscus. 

Accidents, Sequels of Setons. 

The accidents which sometimes follow the application of setons 
are: hemorrhage, gangrenous swellings, abscesses, excessive 
granulations or fungosities, and indurations. 

(a) Hemorrhage. — In ordinary circumstances, their introduc- 
tion is accompanied by the escape of only a few drops of blood, 
but there are cases where abundant hemorrhages occur, either 
resulting from an injury to some blood vessels, or because of a 
special hemorrhagic predisposition in the animal, as when it is in 
a debihtated or anaemic state. 

When there is hemorrhage, it usually shows itself at the con- 
clusion of the operation, the blood oozing in drops from the open- 



ACCIDENTS, SEQUELiE OF SETONS. 199 

ings of the seton, or causing a swelling, if it accumulates in the 
tract. The ordinary means of hemostasis must be employed, as 
cold douches, iced lotions, etc., and if these fail, the seton must 
be removed, and the openings plugged with oakum, moistened 
with hemostatic liquids, or with absorbent cotton ; or it may even 
be necessary to close the openings with sutures, or resort to the 
the appUcation of pressure. Bouley recommended the introduc- 
tion of a thick tent of oakum through the entii'e length of the 
tract. 

{b) Gangrenous Swellings. — These are among the most common 
and dangerous of accidents accompanying setons, and occur prin- 
cipally during warm weather, in debilitated animals, or such as 
are exposed to bad hygienic conditions or affected with some 
special diseases. 

The gangrene manifests itself by the appearance of a warm 
and painful swelliag, oedematous and diffused, spreading rapidly, 
but in the central portion cold and painless, and a general reaction 
soon becomes manifest. The animal becomes dull ; the pulse is 
accelerated and small, and the temperature heightened, the dis- 
charge of the setons has changed its character to that of a thin, 
sanious, and very foetid suppuration. All these symptoms become 
rapidly exaggerated, and soon threaten the life of the patient, 
unless heroic measures are at once resorted to. 

"When the tract assumes this gangrenous aspect the tape must 
be immediately removed, and the tract thoroughly emptied and 
cleansed, by injections of antiseptic liquids such as solutions of 
phenic or salicylic acid, followed by cauterization with the red 
iron in the tract, and through the oedematous swelliag, accom- 
panied by the free administration of tonics and antiseptics inter- 
nally. No means should be neglected likely to overcome the 
threatening septicaemia, which, if not controlled, wiQ certainly have 
a fatal termination. 

(c) Abscesses. — When the seton has been left in place too long, 
or there has been neglect ia respect to the care and cleanliness of 
the tract, or when the tape has been removed, numerous abscesses 
will sometimes be found along the course of the seton. They 
have the character of phlegmonous swellings, and soon become 
fluctuating. 

While they remain superficial, no serious results need be appre- 
hended, and all they require is to be opened to allow the escaj^e 



200 OPEBATIONS ON THE SKIN AND CELLULAE TISSUE. 

of the pus, and to be treated generally after the manner of similar 
tumors in other parts of the body. But occasionally a filtration 
of the pus takes place between the different layers of tissues, and 
the abscesses become troublesome. To avoid their formation 
there must be a complete and regular evacuation of the tract by 
pressing out the contents once a day or oftener, according as 
the discharge requires it. To avoid the possibihty of the migra- 
tion of the pus and the formation of a deep abscess, the operator 
must be careful not to make a false tract with the needle during 
its passage under the skin. 

(d) Excessive Granulations or Jningosities. — These often occur 
at the openings of the tract, when the tape has been left in place 
a long time. They are not of a serious character, and can be re- 
moved by excision or cauterization. 

(e) Jncluratio7is. — These are also among the sequelae of setons 
left in position too long, or when, after the removal of the tape, 
care has not been taken to press out and thoroughly empty the 
tract of any remaining portion of the discharge. These indurations 
appear in the form of long, hardened cords, extending more or 
less in the original length of the setons. They often disappear 
spontaneously, by a slow process of resorption, but in many cases 
it becomes necessary to have recourse to friction with alterative 
ointments composed of preparations of mercury or iodine. Deep 
pointed cauterization, or their entire removal by dissection are also 
recommended. 

ABLATION OF TUMOES. 

Under this heading are included the various modes of the divi- 
sion of tissues involved in the removal of tumors — a tumor being, 
as technically defined, a non-inflammatory mass, constituted by 
tissues of new formation, and having a tendency to persistency 
and possible growth. 

The term ablation, of which the common definition is simply 
taking away, is in surgery employed to denote the excision or re- 
moval of tumors — a tumor being, in a surgical sense, any morbid, 
circumscribed enlargement affecting any of the structures or organs 
of the body, sometimes harmless, and sometimes malignant and 
fatal in their character and termination. 

The surgical means at the disposal of the veterinarian, by 
which this operation is accomplished, are not so numerous as 



ABLATION OF TUMOKS. 201 

those employed in human surgery, and can be comprehended in 
the four principal processes of excision, ligature, tearing and 
puncture. They are about equally employed, according to the 
cu'cumstances and nature of the case, and the discretion of the 
operator. 

1st. — Excision. 

This mode of ablation can be performed in four ways, with 
the scissors, the bistoury, the ecraseur or the thermo-cautery. 

(a) With the Scissors. — This is the simplest process, but is 
apphcable only to tumors of dimiautive size, such as warts, con- 
dyloma, and in general, to growths having a small and narrow 
peduncle. Curved scissors are generally used. The tumor is 
raised from the skin and secured with a pair of bull-dog forceps 
before the scissors are applied. The hemorrhage which may 
foUow is not usually serious, and ordinarily requires no interfer- 
ence, and when necessary, can be readily controlled by means of 
cooHng apphcations, pressure or cauterization. 

(b) With the Bistoury. — When the tumor is comparatively 
small, with a narrow peduncle, its removal is effected in the same 
manner as with the scissors, the only change being in the stroke 
of the instrument. Usually a single stroke of the bistoury is suf- 
ficient. But if the tumor is of large dimensions and covered by 
the skin, the operation becomes more compHcated and requires 
more time and care. It is ordinarily divided into three steps, viz. : 
the incision of the skin, the dissection of the tumor, and its extir- 
pation. 

The form and size of the incision must of course correspond 
to those of the tumor, which must be considered in reference 
to its basis, connections, adhesions and surrounding tissues, as 
weU as the healthy or morbid condition of the teguments. The 
straight incision is applicable to subcutaneous tumors, free from 
adhesions or comparatively loose and susceptible of enucleation, 
while that made thi-ough a fold of the skin is better adapted to 
encysted growths, which it would be dangerous to open. The 
elliptic incision is used when a portion of the skin is to be removed, 
because of its being diseased or too thin, and its closing up would 
be too difficult; or when the extent of the skin exceeds that of 
the wound it covers. Crucial incisions, or those of the T or Y 
shape, are indicated when a tumor of large size is to be exposed, 



202 OPEKATIONS ON THE SKIN AND CELLULAB TISSUE. 

while it is necessary to preserve the skin which covers it. What- 
ever form of incision may be used, it must always extend beyond 
the base of the tumor to allow a free dissection and an easy removal 
of aU the diseased tissues. The convex bistoury is preferred in 
this step of an operation and must be applied with light pressure, 
and a very guarded motion, to avoid any subcutaneous blood ves- 
sels that may run over the surface of the growth, and which may 
be of large size. 

The incision is followed by the dissection, which is done with 
the scalpel or the bistoury, by separating the tumor from the teg- 
uments, carefully avoiding siirrounding structures, which should 
be held aside with the forceps or tenaculum, in order to keep 
the wound open and accessible. Instead of the scalpel or bis- 
toury, the blunt end of the scissors sometimes becomes the in- 
strument by which the adhesions of the cellular tissue covering 
the tumor are most easily destroyed. 

In the third step, or the extirpation of the tumor, either the 
bistoury, the scalpel or the sage knife may be the most eligible in- 
strument, according to the consistency of the tumor, whether hard, 
cartilaginous or bony If it is of sufficiently small size, by steady- 
ing it with the forceps or tenaculum, it may be excised with a 
single stroke of the instrument. If too large for this, it may be 
controlled by passing a loop of ribbon or taj)e through it, by which 
its position can be changed at pleasure, to facilitate its complete 
dissection. The hemorrhage following may be arrested by any of 
the usual hemostatic measures. When the tumor is of large di- 
mensions this last step of the operation will require great care in 
the execution, and the blood vessels which may run through its 
base must be securely ligated before the tumor is entirely excised. 




Fig. 225. — Ecraseur of C'hassaignac. 



ABLATIOX OF TUMORS. 



203 



(c) Wtth the Ecraseur. — The instrunaent used in this method 
has received its name from the fact of its crushing action upon the 
tissues upon which it is appHed and for which it was invented by 
Chassaignac. The original form of the instrument of Chassaig- 
nac has been subjected to various modifications, some being made 
to use with a chain alone, others to carry a wire, and others 
again to carry a chain or a wire alternately. Others like that of 
Keynal, of Miles, of Smith, and many others, vary also in shape or in 
size, but without differing in their general principles, and whether 
employed for the removal of tumors, or in special operations, as 




Fig. 287.— Ecraseur with Wire. 




Fig. 338.— Ecraseur with Chain or Wire. 



those of castrations in males, or spaying in females, the modus 
operandi remains the same. This consists in enclosing the base 
or pediincle of the tumor with the chain or wire of the instru- 
ment, and tightening it more or less rapidly at the discretion of 
the operator, by means of the screw in the handle until it is com- 
pressed, strangulated and crushed, and at last entirely separated. 
The action should be more or less gradual, according to the size 
of the parts and the consistency and vascularity of the tissues. A 



204 OPERATIONS ON THE SKIN AND CELLULAR TISSUE. 




Fig. 229.— Ecraseur of Reynal. 



Pig. 289a.— Haussman Ecraseur. 

slow movement of the ecraseur is essential to avoid hemorrhage, 
but although this rule is recommended by European authors, it 
does not seem to be as important as it is reported to be, if we 
may judge by the results obtained by American practitioners, in 
view of the manner in which they use this instrument in the 
operations of castration. Our experience, however, justifies a 
slow and careful application of the crushing process, especially in 
the removal of tumors where blood vessels of large size or in a 
state of disease may be known to ramify, and particularly in the 
ablations of the champignon of castration. 



ABLATION OF TUMOKS. 205 

{d) With the Thermo- Cautery. — The ablation of tumors can 
also be performed with the flat platinum cautery of Paquelin, 
well heated, by following the same rules as with the bistoury, 
both when either the growths are small, or the incision of the skin 
and dissections of the tumor have been previously performed. 
The advantages gained by the use of the red-heated cautery in 
controlling the hemorrhage while the incision goes on, is too ob- 
vious and important to be ignored or depreciated. 

2d. — Ligature. 

The Hgature operates on the tumor in its own peculiar and 
effective way, by circumscribing the base and depriving it of its 
nutriment by occluding the circulation and leaving it to undergo 
the process of gangrenous dissolution and sloughing, with the ad ■ 
vantage of obviating any apprehended danger of subsequent hem- 
orrhage. The kind of Hgatures used for this purpose will vary 
with the choice of the practitioner. In veterinary surgery, the 
material is variously flax, hemp, silk, catgut, india rubber cords, or 
metaUic wire. WhijDcord or fishing line is often used, when a 
powerful constriction is to be apphed, and their efficiency is in- 
creased by being waxed or soaped. There are various ways of 
applying a Hgature, but they are all subject to the following rules : 
the size of the ligature must be proportioned to that of the parts 
to be ligated, and to their resistance ; it ought to be applied only 
upon a limited portion of the tissues, and the skin ought never to 
be included, except when the peduncle is very narrow, or the skin 
already ulcerated. 

First Method, Simple Ligature. — A cord or band is affixed 
around the base of the tumor, and tightly tied by a single knot. 
Sometimes the bleeding knot or double clove-hitch is preferred, 
drawn tightly and secured by a simple knot. 

The mortification of the growth may be accelerated, if thought 
proper, by covering the ligature with some caustic preparation, 
such as an ointment of sulphide of arsenic, or also by adding to 
the effect of the hgature that of the actual cautery. 

Second Method, Double Ligature. — This is 
brought into requisition when the peduncle of the 
tumor is too large to be easily embraced by a sin- 
gle Hgature. It is made by piercing the base of the j^j^ sso—Tapestry 
growth through the centre, by means of a straight Ligature. 




206 OPERATIONS ON THE SKIN AND CELLULAE TISSUE. 

needle with a double thread or cord, thus dividing the growth 
into separate halves, each having its own distinct hgature, tied 
on opposite sides of the peduncle. 

Third Method^ Multiple Ligature. — At times, the tumor may 
have a sufficiently wide base to require the addition of a third 
ligature in order to secure a sufficient amount of constriction to 
slough the entire mass, in which case special needles become 
necessary. These are longer than the ordinary ones, though 
more or less flexible, and with an eye in the centre, additional to 
that at the extremity, according to indications. 

When the tumor is to be divided into three portions two 
needles are necessary, and a correspondingly long thread. The 
needles being passed together through the base of the tumor, with 
sufficient intervals between to divide it into three nearly equal 




Fig. 231.— Treble Ligature. 

parts, leave, when drawn through, three Hgatures with which to 
enclose separately the central and two lateral portions of the 
peduncle. 

If it becomes necessary to apply four ligatures, two different 
needles are necessary, one (female) long, having an eye in the 



Fig. 232.— Female Needle. Fig. 238.— Male Needle. 

centre, and another (male) of the ordinary form, with the eye at 
its extremity, but of a size which will permit its passage with a 
double thread through the central eye of the other. This male 
needle is to carry a long, double thread. The manipulation is 
very obvious. The first needle is inserted far enough to bring 
the central eye half way through the growth, and the second 
needle is passed through it, and out at the other side ; then, draw- 
ing out the first, two double ligatures are left, or one for each 
quarter of the tumor. All that then remains is the tying of the 
four knots. 

To describe it more in detail, the female needle is inserted in 



ABLATION OF TUMORS. 



207 





Fig. 234.— let Step of the Ligature 
by Four. 



Fig. 235.— Sd Step of the Ligature 
by Four. 



the growth until the eye reaches the centre, when the male needle 
is introduced at a right angle with it, and passed through the eye, 
as in Fig. 234, to be drawn out on the opposite side of the tumor 
carrying the ligatures with it (Fig. 235). 

In the second step of the operation, the passage of the male 
needle through the tumor with the double ligature is completed, 
and by the sej)aration of the needle from one of the threads, two 
threads are left loose. The female needle is then pushed through 
the ttunor, when one of the threads is cut off (Fig. 236) ; the fourth 
step being completed by having the female needle drawn back 




Fig. 336.-3(1 Step of the Ligature 
by Four. 




Fig. 23r.^th step of the Ligature 
by Four. 



through its original tract with the last threads or loop (Fig. 237), 
and when the needle is finally separated, it leaves the tumor divided 
into four segments by four threads, whose extremities are drawn 
and tightly secured by a single knot (Figs. 238, 239). 



208 



OPERATIONS ON THE SKIN AND CELLULAR TISSUE. 





Pig. 239 —The Liga- 
tures Secured. 



Fig. 238.— The Tumor divided 
in Four. 

Fourth Method, Subcutaneous Ligature. — This method is sel- 
dom practiced, as there are always objections to leaving under 
the skin the mortified structures divided by the constriction of the 
cord. But as there may be circumstances under which the growth 
cannot be immediately uncovered, its application becomes a ques- 
tion of necessity. 

Three needles are required: one, A, straight and sharp; the 
second, B, straight and pointed; the third, C, curved and also 
pointed. These are placed upon a single long thread. 




Fig. 240.— Tliread and Needles for Subcutaneous Ligatures. FiG. 241.— 1st Step. 

The growth A being subcutaneous, and spherical in shape, a 
vertical cutaneous fold is raised above its superior thu'd, through 
the base of which the needle A is introduced. Leaving the fold 
loose, and the skin resuming its position, a first portion of hga- 
ture is fovmd in place, under the teguments, surrounding one- 
third of the circumference at C (Fig. 241). The curved needle, C, 
is then passed through the tumor, entering at C, and coming out 
at B, with the loop D, and at B the needle is removed (Fig. 242). 

By these first steps of the operation, the superior third of the 
growth is surrounded by the loop of thread B, C, D, both of whose 



ABLATION OF TUMOKS. 



209 





Fig. 242.— 2d Step. 



Fig. 243.— 3d Step. 



extremities come out by the same opening (Fig.. 243), while a sec- 
ond thread, f f, is free between the superior and the two lower 
thii'ds of the tiimor (Fig. 244). 

The manipulations for the superior third of the growth are 
repeated for the lower third, with another thread, and the middle 
thkd is then surrounded by two parallel threads A, B and C, D 
(Fig. 245). 





Fig. 244.— 4th Step. Fig. 245.— 5tli Step. 

Both of these two threads are passed into the curved needle, 
and it then becomes easy to carry vmder the skin the extremity of 
the thread B to the opening D, and the thread A to the opening 
C, where it will be tied to thread B. All the threads A, B, C, D 
will thus form a loop embracing the middle third of the growth, 
as the other threads will siuTound the upper and the lower thirds. 
All the ligatures can be then tied to the required degree and the 
operation is completed (Figs. 246, 247). 





Fig. 246.- The Ligatures in 
Position. 



Fig. 247.— The Ligature 
Secured. 



When the Hgature that is to apply the necessary constriction 
upon the base of the tumor is in place, it must be tied more or 



210 OPERATIONS ON THE SKIN AND CELLULAR TISSUE. 

less suddenly and firmly, but never with sufficient force to pro- 
duce an immediate section, an operation whicli could have been 
more easily performed, and with less pain, with the bistoury. To 
avoid this section, apply the constriction slowly, and in accordance 
with the effects produced, and the resistance encountered by the 
ligature. If the tissues are soft and frangible, it would be unsafe 
to com]3lete the constriction at once, and it should be deferred 
to a later period ; if, on the contrary, it is hard and resisting, the 
ligature may be drawn tightly, and firmly tied at once. Ordinary 
traction on the ligature may be made with the hands only, but 
when extra strong and steady traction is required, wooden holders 
will prove of great assistance. These means of securing the Uga- 
ture on the tumor are successful so long as it is comparatively 
superficial, but if it is situated at a certaia depth, special instru- 
ments are required. Among these is one particularly adapted to 
the removal of growths from the natural cavities, such as the 
nasal, rectal, vaginal or inguinal regions. It consists of a wooden 
or metallic tube, of variable length, through which the loop of a 
double, strong, waxed Hgature can be introduced into the cavity 




Fig. 248.— Ligature Carrier. 

and adjusted around the base of the tumor, and when in position, 
tightened by traction on the thread at the mouth of the tube, and 
so secured that the constriction can be maintained at any degree 
of tightness, and increased or relaxed at pleasure. 

3d. — Elastic Ligature. 

This is but a variation from the ordinary Hgature, in which 
an india-rubber cord or tubing of suitable diameter is substi- 
tuted for the other means of constriction. It is applied like the 
others at the base of the tumor, and secured in the same manner. 
The pecuHarity of its action arises, of course, from its elasticity, 
the result of which is a constant unrelaxing, self-regulating con- 
striction, which continues automatically untO. the ablation is 
effected. 

The growth upon which the elastic ligature is aj^plied soon 
begins to undergo changes, which may be at first unnoticeable. 



ABLATION OF TUMORS. 211 

But presently it becomes cooler, the skiu becomes soft, flabby, 
and of a dark brownish color ; the mass becomes dry and con- 
tracted, and in from fifteen to twenty days it drops off, leaving a 
wovmd which heals in the usual manner. 

The use of this Hgature is, we beheve, principally advantage- 
ous for small growths, and we have obtained good results from it 
in the castration of medium or small-sized animals, as well as in the 
treatment of small and superficial tumors, as warts, and the like. 
But in respect to large growths, such as the fibromas of the elbow 
joint, from the enormous size of the wound which follows, and 
the excessive length of time this requires to heal, we cannot feel 
justified in recommending it in similar cases. 

4th. — Removal by Tearing. 

This is a method of extirpating tumors by mere force, grasp- 
ing them with one hand or with the forceps, and with the other 
they are simply — with a twisting motion — torn from their connec- 
tion. Of course it can only be practiced on small growths, but it 
has the advantage of preventing hemorrhage, and can be performed 
with the hands alone, or with the assistance of special forceps or 
nippers. The principal objection is that it sometimes fails to 
remove the fundamental element of the growth, and a renewal 
of the trouble may be looked for. 

5th. — Puncture. 
This subject has already been partially considered. It is per- 
formed with either the bistoury, the lancet, or the trocar, but it 
is principally applicable to soft tumors only, and as by its un- 
aided action it is ordinarily insufficient to effect their complete 
disappearance, it becomes necessary to resort to instrumental help, 
in which cauterization with the pointed red iron, bhstering appHca- 
tions, or the injection of irritating or modifying compounds, as 
solution of tincture of iodine, become the ef&eient adjuncts, if not 
in truth the actual curatives. 



CHAPTER VI. 



OPERATIONS ON BONES. 



FRACTURES. 

In technical language a fracture is a " solution of continuity in 
the structure or substance of a bone," and it ranks among the 
most serious of the lesions to which the horse — or any animal — 
can be subject. It is a subject of special interest to veterinarians, 
and to horse owners as well, in view of the variety of forms in 
which it may occur, as well as of the loss of time to which it sub- 
jects the patient, and the consequent suspension of his earning 
capacity. Though of less serious consequence in the horse than 
in man, it is always a matter of grave import. It 
is always slow and tedious in healing, and is fre- 
quently of doubtful and unsatisfactory result. 

This solution of continuity may take place in 
two principal ways. In the most numerous in- 
stances it includes the total thickness of the bone 
and is a complete fracture. In other cases it in 
volves a portion only of the thickness of the bone, 
and for that reason is described as 
incomplete (Fig. 250) If the bone 
is divided into two separate portions, 
and the soft parts have received no 
injury, the fracture is a simple one ; 
or it becomes compound if the soft 
parts have suffered laceration, and 
comminuted if the bones have been 
crushed or ground into fragments, 
many or few. The direction of the 
break also determines its further 
classification. Broken at a right an- 
gle, it is transverse (Fig. 251) ; at a 
Fig. 249.-Complete »' "^ *= \ 

Fracture different angle it becomes oolique 





FRACTURES. 



213 



(Fig. 252), and it may be longitudinal or lengthwise. In a com- 
plete fracture, especially of the oblique kind, there is a condition 
of great importance in respect to its effect upon the ultimate re- 
sult of the treatment, in the fact that from various causes, such as 
muscular contractions or excessive motion, the bony fragments do 
not maintain their mutual coaptation, but become separated at the 
ends, and this fact has made it necessary to add another descrip- 
tive term in the words — loith displacement. And this term again 
suggests its negative, and introduces the fracture without disjjlace- 




PlG. 251.— Transverse 
Fracture of the Radius. 



Fig. 252.— Oblique Frac- 
ture of the Femur. 



214 OPEEATIONS ON BONES. 

merit, when the facts justify this description. Again, a fracture 
may be intra-articular or extra-articular, as it extends within a 
joint or otherwise, and once more, intra-periosteal, when the peri- 
osteum remains intact. And, finally, there is no absolute limit to 
the use of descriptive terminology in the case. 

The condition of displacement is largely influential in deter- 
mining the question of treatment, and as affecting the final result 
of a case of fracture. This, however, is dependent npon its loca- 
tion or whether its seat be in one or more of the axes of the bone, 
in its length, its breadth, its thicknsss, or its circumference. An 
incomplete fracture may also be either simple or comminuted, the 
periostevim, in the latter case when it is intact, keeping the frag- 
ments together, the fracture in that case belonging to the intra,- 
periosteal class. At times there is only a simple fissure or split 
in the bone, making a condition of much difficulty of diagnosis. 

Two varieties of originating cause may be recognized in cases 
of fracture. They are the predisposing and the occasional. As 
to the first, diflerent species of animals difi'er in the degree of their 
liabihty. That of the dog is greater than that of the horse, and, in 
horses, the various questions of age, the mode of labor, the season 
of the year, the portion of the bodj^ most exposed, and the existence 
of ailments, local and general, are all to be taken into account. 

Among horses, those employed in heavy draught work or that 
are driven over bad roads, are more exposed than light-draught 
or saddle horses, and animals of different ages are not equally 
liable. Dogs and young horses, with those which have become 
sufficiently aged for their bones to have acquired an enhanced 
degree of frangibUity, are more hable than those which have not 
exceeded the time of their adult prime. The season of the year 
is undoubtedly, though in an incidental way, an imjDortant factor 
in the problem of the etiology of these accidents, for though they 
may be observed at all times, it is during the months when the 
slippery condition of the icy roads renders it difficult for both 
men and beasts to keep their feet, that they occur most frequently. 
The long bones, those especially which belong to the extremities, 
are most frequently the seat of fractures, from the circumstance of 
their superficial position ; their exposure to contact and collision, 
and the violent muscular efforts involved both in their constant 
rapid movement and their labor in the shafts or at the pole of 
heavy and heavily laden carriages. 



FKACTUKES. 215 

The relation between sundiy idiosyncrasies and diatheses and 
a liability to fractures is too constant and well established a path- 
ological fact to need more than a passing reference. The history 
of rachitis, of melanosis, and of osteo-porosis, as related to an 
abnormal frangibihty of the bones, is a part of our common medi- 
cal kaowledge. There are few persons who have not known of 
cases among their friends of frequent and almost spontaneous 
fractures, or at least of such as seem to be produced by the 
sHghtest and most inadequate violence, and there is no tangible 
reason for doubting an analogous condition in individuals of the 
equine constitution. Among local predisposing affections, mention 
must not be omitted of such bony diseases as caries, tuberculosis, 
and others of the same class. 

Occasional or "efficient" causes of fracture are in most 
instances external tra.umatisms, as violent contacts, collisions, 
falls, etc., or sudden muscular contractions. These external acci- 
dents are various in their character, and are usually associated 
with quick muscular exertion. A violent, ineffectual effort to 
move too heavy a load ; semi-spasmodic bracing of the frame to 
avoid a fall or resist a pressure; a quick jump to escaj)e a blow; 
stopping too suddenly after speeding; struggling to liberate a 
foot from a rail — perhaps to be thrown in the effort — all these are 
familiar and easy examples of accidents happening hourly, by 
which our equine servants become sufferers. We may add to 
these the fracture of the bones of the vertebrae, occurring when 
a patient is cast for the purpose of undergoing a siu'gical opera- 
tion, quite as much the result of muscular contraction as of a pre- 
existing diseased condition of the bones. A fracture occurring 
under these circumstances may be called with propriety indirect, 
while one which has resulted from a blow or a fall differently 
caused is of the direct kind. 

The symptoms belonging to the existence of fracture vary ac- 
cording to the site of the lesion. In case of its being on a bone 
of the extremity there is irregularity in the jDcrformance of the 
functions of the apparatus to which the fractured bone belongs, 
and as a necessary consequence of the existing lesion, lameness 
more or less marked. If the broken bone belongs to one of the 
extremities, the impossibility of the performance of its natural 
function, in sustaining the weight of the body and contributing to 
the act of locomotion, is usually complete, though the degree of 



216 OPEBATIONS ON BONES. 

poweiiessness will vary according to the kind of fracture and the 
bone which is injured. For example, a fracture of the cannon 
bone without displacement, or of one of the phalanges which are 
surrounded and sustained by a complex fibrous structure, is, in a 
certain degree, not incompatible with some amount of resting of 
the foot. But, on the contrary, if the shank bone, or that of the 
forearm be the impHcated member, it woiild be very difficult for 
the leg to exercise any agency whatever in the support of the 
body. And in a fractvire of the lower jaw, it would be obviously 
futile to expect it to contribute materially to the mastication of 
food. 

A fracture seldom occurs which is not accompanied with a 
degree of deformity, greater or less, of the region or the leg 
affected. This is due to the exudation of the blood into the 
meshes of the surrounding tissues and to the displacement which 
occairs between the fragments of the bones, with subsequently 
the swelling which follows the inflammation of the surrounding 
tissues. The character of the deformity will mainly depend upon 
the manner in which the displacement occurs. 

In a normal state of things the legs perform their movements 
with the joints as their only centres or bases of action, with no 
participation of intermediate points, while with a fracture the 
flexibility and motion which will be observed at unnatural points 
are among the most strongly characteristic signs of the lesion. 
No one need be told that when the shaft of a limb is seen to bend 
midway between the joints, with the lower portion swinging 
freely, that the leg is broken. But there are still some conditions 
where the excessive mobility is not easy to detect with certainty. 
Such are the cases where the fracture exists in a short bone, near 
a movable joint, or in a bone of a region where several short and 
small bones are united in a group, or even in a long bone where 
its situation is such that the muscular covering prevents the 
visible manifestation of the symptom. 

If the situation of a fracture precludes its discovery by means 
of this abnormal flexibihty, other detective methods remain. And 
after all there is one decisive sign which, though it may not avail 
in every case, as it does not, is in cases where its testimony can 
be secured absolute and positive beyond question. This is cre^)- 
itation, or the pecvdiar effect which is produced by the friction 
of the fractured surfaces one against another. Though discerned 



FRACTUKES. 217 

by the organ of hearing, it can scarcely be called a sound, for the 
grating of the parts, as the rubbing takes place, is often more felt 
than heard, but there is no mistaking its import in cases favorable 
for the aj)pHcation of the test. The conditions in which it is not 
available are those of incomplete fracture, in which the mobility 
of the parts is lacking ; and those in which the whole array of 
phenomena are usually obscure. To obtain the benefit of this 
pathognomonic sign requires deliberate, careful, and gentle man- 
ipulation. Sometimes the sHghtest movements will be sufficient 
for its development, after much rougher handling has failed to 
discover it. Perhaps the failure in the latter case is due to a sort 
of defensive spasmodic rigidity caused by the pain resulting from 
the rude interference. 

More or less reactive fever is a usual accompaniment of a frac- 
ture, and an ecchymosis of the joarts is but a natural occurrence, 
more easily discovered in animals possessing a light-colored and 
deHcate skin than in those of the opposite character. 

There are difficulties in the way of the diagnosis of an incom- 
plete fracture, even sometimes when there is a degree of impair- 
ment in the function of locomotion, Avith evidences of pain and 
swelling at the seat of lesion. There should then be a careful 
examination for the evidences of a blow or other violence sufficient 
to account for the fracture, though very often a suspicion of its 
existence can only be converted into a certainty by a minute his- 
tory of the patient if it can be obtained up to the moment of the 
occurrence of the injury. A diagnosis ought not to be hastily 
pronounced, and where good ground for suspicion exists it ought 
not to be rejected upon any evidence less than the best. Serious 
and fatal comphcations are too often recorded of the results fol- 
lowing careless conclusions in similar cases, among which we may 
refer to one instance of a complete fracture manifesting itself in 
an animal during the act of rising up in his stall after a decision 
had been pronounced that he had no fracture at all. 

Fractures are of course liable to comphcations, those especial- 
ly, from the natui'e of the case, which are of a traumatic 
character, such as extensive lacerations, tearing of tissues, punc- 
tures, contusions, etc. But unless these are in communication 
with the fracture itself, the indication is to treat them simply 
as independent lesions upon the other parts of the body. A 
traumatic emphysema will at times cause trouble, and abscesses, 



218 OPERATIONS ON BONES. 

more or less deep and diffused, may follow. In some cases small 
bony fragments from a comminuted fracture, becoming loose and 
acting as foreign bodies, may give rise to troublesome fistulous 
tracts. A frequent complication is hemorrhage, which often be- 
comes of serious consequence. A fracture in close proximity to a 
joint may be accomjianied by dangerous inflammations of im- 
portant organs, and may induce an attack of pneumonia, pleurisy, 
arthritis, etc., as well as luxations or dislocations, and the more 
so if situated near the chest. Ga7igrene, as a consequence of 
contusions or of hemorrhage or of an impediment to the circula- 
tion, caused by unskill fully applied apparatus, must not be over- 
looked among the occasional incidents ; nor must lockjav:i, which 
is not an uncommon occurrence. Even laminitis has been met 
with as the result of forced and long-continued immobility of the 
feet in the standing postiire, as one of the involvements of una- 
voidably protracted treatment. 

AVhen a simple fracture has been properly treated, and the 
broken ends of the bone have been securely held in coaptation, one 
of two things will occur. Either — and this is the more common 
event — there will be a union of the two ends by a solid cicatrix, 
the callus, or the ends will continue separated or become only 
partially united by an intermediate fibrous structure. In the 
first instance the fracture is consohdated, or united, in the second 
there is a false articulation, ox pseiido-arthrosis. 

The time required for a firm union or true consoHdation of a 
fracture will vary with the character of the bone affected, the age 
and constitution of the patient, and the general condition of the 
case. The union will be perfected earlier in a young than in an 
adult animal, and sooner in the latter than in the aged, and a 
general healthy condition is of course, in every respect, an 
advantage. 

The mode of cicatrization, or method of repair in lesions of 
the bones, has been a subject of much study among investigators 
in pathology, and has ehcited various expressions of opinion from 
those high in authority. But the weight of evidence and pre- 
ponderance of opinion are about settled in favor of the theory 
that the law of reparation is the same for both the hard and the 
soft tissues. In one case a simj^le exudation of material, with the 
proper organization of newly formed tissue, will bring about a 
union by the first intention, and in another the woi'k will be ac- 



FRACTURES. 



219 



companied by suppuration, or the \inion by the second intention, 
a process so familiar in the repair of the soft structures by 
granulation. 

Considering the process in its simplest form, in a case in which 
it advances without interruption or complication to a favorable 
result, it may probably be correctly described in this wise : 

On the occurrence of the injtiry an effusion of blood takes 
place between the ends of the bone. The coagulation of the fluid soon 
foUows, and this, after a few days, undergoes absorj)tion. There 
is then an excess of inflammation ia the surrounding structure, which 
soon spreads to the bony tissue, when a true ostitis is established, 
and the compact tissvie of the bone becomes the seat of a new 
vascular organization, and of a certain exudation of plastic lymph, 




Fig. 253.— Fracture of the Common Bone, with Callus. 



220 OPERATIONS ON BONES. 

appearing between the periosteum and the external surface of the 
bone, as well as on the inner side of the medullary cavity. After 
a few days the ends of the bone thus surrounded by this exudate 
become involved in it, and the lymph, becoming vascular, is soon 
transformed into cartilaginous, and in due time into bony tissue. 

Thus the time required for the consolidation of the fractured 
segments is divisible into two distinct periods. In the first they 
are surrounded by an external bony ring, and the medullary cavity 
is closed by a bony plug or stopper, constituting the period of the 
provisional callus. This is followed by the period of permanent 
callus, during which the process is going forward of converting 
the cartilaginous into the osseous form. 

The restorative process is sooner completed in the carnivorous 
than in the herbivorous tribes. In the former the temporary callus 
may attain sufiicient firmness or consistency for the careful use 
of the limb within four weeks, but with the latter a period of from 
six weeks to two months is not too long to allow before removing 
the supporting apparatus from the Hmb. 

This in general terms represents the fact when the resources 
of nature have not been thwarted by untoward accidents, such as 
a want of vigor in the constitution of the patient or a lack of skill 
on the part of the practitioner, and especially when, from any 
cause, the bony fragments have not been kept in a state of perfect 
immobility and the constant friction has prevented the osseous 
union of the two portions. Failures and misfortunes are always 
more than possible, and instead of a solid and practicable bony 
union the sequel of the accident is sometimes a false joint, com- 
posed of mere flexible cartilage, a poor pseudo-arthrosis. The ex- 
planation of this appears to be that, first, the sharp edges of the 
ends of the bone disappear by becoming rounded at their extrem- 
ities, by friction and polishing against each other. Then follows 
an exudation of a plastic nature, which becomes transformed into 
a cartilaginous layer of a rough articular aspect. In this, bony 
nuclei soon appear, and the lymph secreted between the segments 
thus transformed, instead of becoming truly ossified, is changed 
into a sort of fibro-cartilaginous pouch or capsular sac, in which 
a somewhat albuminous secretion, or pseudo-synovia, permits the 
movement to take place. Most commonly, however, in our 
animals, the union of the bony fragments is obtained wholly 
through the medium of a layer of fibrous tissue, and it is because 



FRACTUEES. 221 

the union lias been accomplished by a ligamentous formation only, 
that motion becomes jjracticable. 

The prognosis in a case of fracture in an animal is one of the 
gravest vital import to the patient, and therefore of serious pecu- 
niary concern to his owner. The period has not long elapsed 
when to have received such a hurt was quite equivalent to under- 
going a sentence of death for the suffering animal, and perhaps 
to-day a similar verdict is pronounced in many cases in which the 
exercise of a httle mechanical ingenuity, with a due amount of 
careful nursing, might secure a contrary result and insvu-e the re- 
turn of the patient to his former condition of soundness and use- 
fulness. Considered per se, a fracture in an animal is in fact no 
less amenable to treatment than the same description of injury in 
any other hving being. But the question of the propriety and 
expediency of treatment is dependent upon certain specific points 
of collateral consideration. 

First. The nature of the lesion itseK is a point of paramount 
importance. A simple fracture occurring in a bone where the 
ends can be firmly secured in coaptation, presents the most favor- 
able conditions for successful treatment. If it be that of a long 
bone it will be the less serious if situated at or near the middle of 
its length than if it were in close proximity to a joint, from the 
fact that perfect immobility can rarely, in the latter case, be 
secured without incurring the risk of subsequent rigidity of the 
joint. 

A simple is always less serious than a compound fracture. A 
comminuted is always more dangerous than a simple, and a trans- 
verse break is easier to treat than one which is oblique. The 
most serious are those which are situated on parts of the body in 
which it is difficult to secure perfect immobility, and especially 
those w^hich are accompanied by severe contusions and lacerations 
in the soft parts ; the protrusion of fragments through the skin ; 
the division of blood vessels by the broken ends of the bone ; the 
existence of an articulation near the point to which inflammation 
is likely to extend ; the luxation of a fragment of the bone ; lacer- 
ation of the periosteum ; the presence of a large number of bony 
particles, the result of the crushing of the bone — all these are cir- 
cumstances which discourage a favorable prognosis, and weigh 
against the hope of saving the patient for future usefulness. 

Fractures which may be accounted curable are those which are 



222 OPERATIONS ON BONES. 

not conspicuously visible, as those of the ribs, where displace- 
ments are either very limited or do not occur, the j)arts being kept 
in situ by the nature of their position, the shape of the bones, the 
articulations they form with the vertebrae, the sternum, or their 
cartilages of prolongation ; those of transverse processes of the 
lumbar vertebrae ; those of the bones of the face ; those of the ili- 
um, and that of the cof&n bones. To continue the category, they 
are evidently curable when their position and the character of the 
patient contribute to aid the treatment. Those of the cranium, 
in the absence of cerebral lesions ; those of the jaws, of the ribs, 
with disjDlacement, of the hij), and those of the bone of the leg in 
movable regions, but where their vertical position admits of per- 
fect coaptation. 

On the contrary, a compound, complicated, or comminuted 
fracture, in whatever region it may be situated, may be accounted 
incurable. 

In treating fractures, time is an important element and " de- 
lays are dangerous." Those of recent occurrence unite more easi- 
ly and more regularly than older ones. 

/Second. As a general rule, fractures are less seriovis in animals 
of the smaller species than in those of more bulky dimensions. 
This influence of species will be readily appreciated when we real- 
ize that the difficulties involved in the treatment of the latter class 
have hardly any existence in connection with the former. The 
difference in weight and size, and consequent facility in handling, 
and making the necessary applications of dressings and other ajD- 
pliances for the purpose of securing the indispensable immobility 
of the parts, and usually a less degree of uneasiness in the de- 
portment of the patients are considerations in this connection of 
great weight. 

Third. In respect to the utilization of the animal, the most 
obvious point in estimating the gravity of the case in a fracture 
accident is the certainty of the total loss of the services of the pa- 
tient during treatment — certainly for a considerable period of 
time, perhaps permanently. For example, the fracture of the jaw 
of a steer just fattening for the shambles will involve a heavier 
loss than a similar accident to a horse. Usually the fracture of 
the bones of the extremities in a horse is a very serious casualty, 
the more so proportionately as the higher region of the limb is 
affected. In working animals it is exceedingly difficult to treat a 



FRACTURES. 223 

fracture in such a manner as to restore a limb to its original per- 
fection of movement. A fracture of a single bone of an extremity 
in a breeding stallion or mare will not necessarily impair their 
value as breeders. Other specifications under this head, though 
pertinent and more or less interesting, may be omitted. 

Fourth. Age and temper are important factors of cuu*e. A 
young, growing, robust patient, whose tns vitce is active, is amen- 
able to treatment which one with a waning constitution and past 
mature energies would be unable to endure, and a docile, quiet 
disposition will act co-operatively with remedial measures which 
would be neutralized by the fractious opposition of a peevish and 
intractable siifferer. 

The fulfillment of three indications is indispensable in all frac- 
tures. The first is the reduction, or the replacement of the parts 
as nearly as possible in their normal position. The second is their 
retention in that position for a period sufficient for the formation 
of the provisional callus, and the third, which in fact is but an in- 
cident of the second, the careful avoidance of any accidents or 
causes of miscarriage which might disturb the curative process. 

In reference to the first consideration, it must be remembered 
that the accident may befall the patient at a distance from his 
home, and his removal becomes the first duty to be attended to. 
Of course this must be done as carefully as possible. If he can 
be treated on the spot so much the better, though this is seldom 
practicable, and the method of removal becomes the question call- 
ing for settlement. But two ways present themselves — he must 
either walk or be carried. If the first, it is needless to say that 
evei'y caution must be observed in order to obviate any additional 
pain for the suffering animal, and to avoid any aggravation of the 
injury. Led slowly, and with partial support if practicable, the 
journey will not always involve untoward residts. If he is carried 
it must be by means of a wagon, a truck, or an ambulance ; the 
latter being designed and adapted to the purpose, would, of 
course, be the preferable vehicle. As a precaution which should 
never be overlooked, a temporary dressing should first be jq^phed. 
This may be so done as for the time to answer all the j)urpose of 
the permanent adjustment and bandaging. Without thus secur- 
ing the patient, a fracture of an inferior degree may be trans- 
formed to one of the severest kind, and, indeed, a curable changed 
to an incurable injury. We recall a case in which a fast trotting 



224 OPEKATIONS ON BONES. 

horse, after running away in a fright caused by the whistle of a 
locomotive, was found on the road limping with excessive lame- 
ness in the off fore leg, and walked with comparative ease some 
two miles to a stable before being seen by a surgeon. His imme- 
diate removal in an ambulance was advised, but before that vehi- 
cle could be procured the horse laid down, and upon being made 
to get upon his feet was found with a weU-marked comminuted 
fracture of the os suffraginis, with considerable displacement. 
The patient, however, after long treatment, made a comparatively 
good recovery, and though with a large bony deposit, a ringbone, 
was able to trot among the forties. 

The two obvious indications in cases of fracture are reditction, 
or replacement and retention. 

In an incomplete fracture, where there is no displacement, the 
necessity of reduction does not exist. With the bone kept in 
place by an intact periosteum, and the fragments seciired by the 
uninjured fibrous and ligamentous structure which surrounds 
them, there is no dislocation to correct. It is also at times ren- 
dered impossible by the seat of the fracture itself, by its dimensions 
alone, or by the resistance arising from the muscular contraction 
excited by the surgical manipulation. This is illustrated even in 
small animals, as in dogs, by the exceeding difficulty encountered 
in bringing the ends of a broken femur or humerus together, the 
muscular contraction being even in these animals sufficiently for- 
cible to renew the displacement. 

It is generally, therefore, only fractures of the long bones, and 
then at points not in close proximity to the trunk, that may be con- 
sidered to be amenable to reduction. It is true that some of the 
more superficial bones, as those of the head, of the pelvis, and of 
the thoracic walls may in some cases require special manipulations 
and appliances for their retention in their normal positions, but 
the treatment of these and of a fractured leg cannot be the same. 

The methods of accomplishing reduction vary with the features 
of each case, the manipulations being necessarily modified to meet 
changing circumstances. If the displacement is in the thickness 
of the bone, as in transverse fracture, the manipulation of reduc- 
tion consists in applying a steady pressure upon one of the frag- 
ments, while the other is kept steady in its place, the object of the 
pressure being the re-establishment of the exact coincidence of the 
two bony surfaces. If the displacement has taken place at an 



FEACTUKES. 225 

angle it will be sufficient in order to efiect the reduction to press 
upon the summit or apex of the angle until its disappearance in- 
dicates that the parts have been brought into coaptation. This 
method is often practiced in the treatment of a fractured rib. In 
a longitudinal fracture, or when the fragments are pressed together 
by the contraction of the muscles to which they give insertion 
until they so overlap as to correspond by certain points of their 
cii'cumference, the reduction is to be accomplished by effecting 
the movements of extension, counter-extension, and coax)tation. 
Extension is accomphshed by making traction upon the lower por- 
tion of the limb. Counter-extension consists in firmly holding or 
confining the upper or body portion in such a manner that it 
shall not be affected by the traction applied to the lower ; in sim- 
pler language, holding it motionless against the force exercised in 
the extension. In other words, the operator, grasping the limb 
below the fracture, draws it down or away from the trunk, while 
he seeks, not to draw away, but simply to hold still the upper por- 
tion until the broken ends of bone are brought to theix- natural 
relative positions when the coaptation, which is thus affected, has 
only to be made permanent by the proper dressings to perfect the 
reduction. 

In treating fractures in smaU animals the strength of the hand 
is usually sufficient for the requii-ed manipulations. In the fracture 
of a forearm of a dog, for example, while the upper segment is 
firmly held by one hand, the lower may be grasped by the other 
and the bone itself made to serve the purpose of a lever to bring 
about the desu-ed coaptation. In such a case that is sufficient to 
overcome the muscular contraction and correct the overlaj)ping or 
other malposition of the bones. If, however, the resistance can 
not be overcome in this mode, the upper segment may be committed 
to an assistant for the management of the counter extension, 
leaving to the operator the free use of both hands for the further 
manij^vdation of the case. 

But if the reduction of fractures in small animals is an easy 
task it is far from being so when a large animal is the patient, 
whose muscular force is largely greater than that of several men 
combined. In such a case resort must be had not only to superior 
numbers for the necessary force, but in many cases to mechanical 
aids. A reference to the mode of proceeding in a case of fractm-e 
with displacement of the forearm of a horse will illustrate the 



226 OPERATIONS ON BONES. 

matter. The patient is first to be carefully cast, on the uninjured 
side, with ropes, or a broad leather strap about 18 feet long, j)assed 
under and around his body and under the axilla of the fractured 
limb and secured at a point opposite to the animal and toward his 
back. This will form the mechanical means of counter extension. 
Another rope will then be placed around the inferior part of the 
leg below the point of fracture, with which to produce extension, 
and this will sometimes be furnished with a block or pulleys, in 
order to augment the power when necessary ; and there is, in fact, 
always an advantage in their use, on the side of steadiness and 
uniformity, as well as of increased power. It is secured around 
the fetlock or the coronet, or, what is better, above the knee and 
nearer the point of fracture, and is committed to assistants. The 
traction on this should be firm, uniform, and slow, without relaxing 
or jerking, while the operator carefully watches the process. If 
the bone is superficially situated he is able to judge, by the eye, of 
any changes that may occiir in the form or length of the parts 
under traction, and discovering at the moment of its happening 
the restoration of symmetry in the disturbed region, he gently but 
firmly manipvdates the place until all appearance of severed con- 
tinuity have vanished. Sometimes the fact and the instant of res- 
toration are indicated by a pecuhar sound, or "click," as the ends 
of the bone sHp into contact, to await the next step of the restora- 
tive procedure. 

The process is the same when the bones are covered with thick 
muscular masses, excepting that it is attended with greater diffi- 
culties, from the fact that the finger must be substituted for the 
eye, and the taxis must take the place of the sight, and the result 
naturally becomes more uncertain. 

It frequently happens that perfect coaptation is prevented by 
the interposition between the bony surfaces of substances, such as 
a small fragment of detached bone or a clot of blood, and some- 
times the extreme obhquity of the fracture is the opposing cause, 
by permitting the bones to slip out of place. These are difficulties 
which can not always be overcome, even in smaU-sized animals, 
and still it is only when they are mastered that a correct consoli- 
dation can be looked for. Yet without it the continuity between 
the fragments will be by a deformed callus, the union will leave a 
shortened, crooked or angular Hmb, and a disabled animal. 

If timely assistance can be obtained, and the reduction ac- 



FRACTURES. 227 

complished immediately after the occurrence of the accident, that 
is the best time for it. But if it cannot be attended to until in- 
flammation has become established and the parts have become 
swollen and painful, time must be allowed for the subsidence of 
these symptoms before attempting the operation. A spasmodic 
musciolar contraction, which sometimes interposes a difficulty, may 
be easily overcome by subjecting the patient to general anesthesia, 
and need not, therefore, cause any loss of time. A tendency to 
this may also be overcome by the use of sedatives and anti-phlo- 
gistic remedies. 

The reduction of the fracture having been accomplished, the 
problem which follows is that of retention. The parts which have 
been restored to their natural position must be kept there, with- 
out disturbance or agitation, until the perfect formation of a caUus, 
and it is here that ample latitude exists for the exercise of ingen- 
uity and skOl by the surgeon in the contrivance of the necessary 
apj)aratus. One of the most important of the conditions Avhich 
are available by the surgeon in treating human patients is denied 
the veterinarian in the management of those which belong to 
the animal tribes. This is position. The intelligence of the 
human j)atient co-operates with the instructions of the surgeon, 
but with the animal sufferer there is a contiaual antagonism 
between the parties, and the forced extension and fatiguing posi- 
tion which must for a considerable period be maintained as a con- 
dition of restoration require special and effective appliances to 
insiure successful results. To obtain complete immobility is 
scarcely possible, and the surgeon must be content to reach a 
point as near as possible to that which is unattainable. For this 
reason, as will subsequently be seen, the use of sUngs and the re- 
straint of patients in very narrow stalls is much to be preferred to 
the practice sometimes recommended, of allowing entire freedom of 
motion by turning them loose in box stalls. Temporary and mova- 
ble apparatus are not usually of difficult use in veterinary practice, 
but the restlessness of the patients and their unwillingness to 
submit quietly to the changing of the dressings render it obliga- 
tory to have recourse to permanent and immovable bandages, 
which should be retained without disturbance until the process of 
consolidation is comjolete. 

The materials composing the retaining apparatus consist of 
oakum, bandages and splints, with an agglutinating compound 



228 OPEKATIONS ON BONES. 

which forms a species of cement by which the different constit- 
uents are blended iato a consistent mass to be spread upon the 
surface covering the locahty of the fracture. Its components are 
black pitch, resia, and Venice turpentine, blended by heat. The 
dressing may be applied directly to the skin, or a covering of thin 
hnen may be interposed. A putty made with powdered chalk 
and the white of an egg is recommended for small animals, though 
a mixture of sugar of lead and burnt alum with the albumen is 
preferred by others. Another formula is spirits of camphor, 
Goulard's extract and albumen. Another recommendation is to 
saturate the oakum and bandages with an adhesive solution formed 
with gum arabic, dextrine, flour paste, or starch. This is advised 
particularly for small animals. Dextrine mixed, while warm, with 
burnt alum and alcohol cools and soUdifies into a stony consistency, 
and is preferable to plaster of Paris, which is less friable and has 
less soHdity, besides being heavier and requiring constant additions 
as it becomes older. Starch and plaster of Paris form another 
good compound. 

In applying the dressing the leg is usually padded with a 
cushion of oakum, thick and soft enough to equalize the irregu- 
larities of the surface and to form a bedding for the protection of 
the skin from chafing. Over this the splints are placed. The 
material for these is, variously, pasteboard, thin wood, bark, laths, 
gutta percha, strips of thin metal, as tin or perhaps sheet iron. 
These should be of sufficient length not only to cover the region 
of the fracture, but to extend sufficiently above and below to 
render the immobihty more complete than in the svu-rounding 
joints. The splints again, are covered with cloth bandages, linen 
preferably, soaked in a glutinous moisture. These bandages are 
to be carefully applied, with a perfect condition of lightness. 
They are usually made to embrace the entire length of the leg, in 
order to avoid the possibHity of interference with the circulation 
of the extremity, as well as for the prevention of chafing. They 
should be rolled from the lower part of the leg upward, and 
carefully secured against loosening. In some instances suspen- 
sory bandages are recommended, but excepting for small animals 
our experience does not justify a concurrence in the recommen- 
dation. 

These permanent dressings always need careful watching in 
reference to their immediate effect upon the region they cover, 



FKACTURES. 229 

especially during the first days succeeding that of their applica- 
tion. Any manifestation of pain, or any appearance of swelling- 
above or below, or any odor suggestive of suppuration should 
excite suspicion, and a thorough investigation should follow with- 
out delay. The removal of the dressing should be performed 
with great care, and especially so if time enough has elapsed since 
its appUcation to allow of a probabiUty of a commencement of the 
healing process or the existence of any points of consolidation. 
With the original dressing properly applied in its entirety in the 
first instance, the entii'e extremity will have lost all chance of 
mobility, and the repairing process may be permitted to proceed 
without interference. There will be no necessity and there need 
be no haste for removal or change except under such special con- 
ditions as have just been mentioned, or when there is reason to 
judge that soHdification has become perfect, or for the comfort of 
the animal, or for its readaptation in consequence of the atrophy 
of the limb from want of use. Owners of animals are often 
temj)ted to remove a splint or bandage prematurely at the risk of 
producing a second fracture in consequence of the failure of the 
callus properly to consolidate. 

The method of applj-ing the splints which we have described 
refers to the simple variety only. In a compound case the same 
rules must be observed, with the modification of leaving openings 
through the thickness of the dressing, opposite the wovmd, in 
order to permit the escape of pus and to secure access to the 
points requiring the application of treatment. 

Feactuee of diffeeent Bones, 
Of the Cranial Bones. — Fractures of this variety in large 
animals are comparatively rare, though the records are not desti- 
tute of cases. ^\Tien they occur, it is as the result of external 
violence, the sufferers being usually runaways which have come in 
coUision with a wall or tree, or other obstruction ; or it may occur 
in those which in pulling upon the halter have broken it with a 
jerk and been thrown backward, as might occur in rearing too 
riolently. Under these conditions we have witnessed fractiires of 
the parietal, of the frontal, and of the sphenoid bones. These 
fractures may be of the complete or incomplete kind, which in- 
deed is usually the case with those of the flat bones, and they are 
liable to be complicated with lacerations of the skin, in conse- 



230 



OPEKATIONS ON BONES. 



quence of which they are easily brought under observation. But 
when the fact is otherwise and the skin is intact, the diagnosis 
becomes difficult. The incomplete variety may be unaccompanied 
by any special symptoms, but in the complete kind one of the 
bony plates may be so far detached as to press upon the cerebral 
substance with sufficient force to produce serious nervous com- 
pHcations. ^\Tien the injury occurs at 
the base of the cranium, hemorrhage may 
be looked for, with paralytic symptoms, 
and when these are present the usual ter- 
mination is death. It may still happen, 
however, that the symptoms of an appa- 
rently very severe concussion may dis- 
appear, with the result of an early and 
complete recovery, and the surgeon will 
do well to avoid undue precipitation in 
venturing upon a prognosis. In frac- 
tures of the orbital or the zygomatic 
bones the danger is less pressing than 
with injuries otherwise located about the 
head. The treatment of cranial fractures 
is simple, though involving the best skill 
of the experienced surgeon. When in- 
complete, hardly any interference is need- 
ed; even plain bandaging may usually 
be dispensed with. In the complete va^ 
riety the danger to be combated is com- 
pression of the brain, and attention to 
this indication must not be delayed. The 
means to be employed are the trephining 
of the skull over the seat of the fracture, 
and the elevation of the depressed bone or the removal of the por- 
tion which is causing the trouble. Fragments of bone in commin- 
uted cases, exfoliations, collections of fluid, or even protruding 
portions of the brain substance must be cleansed away, and a 
simple bandage so apphed as to facilitate the application of sub- 
sequent dressings. 

Fractures of the Bones of the Face. — In respect to their origin — 
usually traumatic — these injuries rank with the preceding, and are 
commonly of the incomplete variety. They may easily be over- 




FiG. 254.— Apparatus for Frac- 
ture of the Nasal Bone. 



FRACTURES. 231 

looked and may even sometimes escape recognition until the rep- 
arative process has been well established and the discovery of the 
wound becomes due to the prominence caused by the presence of 
the provisional callus which marks its cure. When the fracture is 
complete it ^viLl be marked by local deformity, mobility of the 
fragments, and crepitation. Nasal hemorrhage, roaring, frequent 
sneezing, loosening or loss of teeth, difficulty of mastication, and 
inflammation of the cavities of the sinuses are varying complica- 
tions of these accidents. The object of the treatment should be 
the restoration of the depressed bones as nearly as possible to 
their normal position, and their retention in place by protecting 
splints, which should cover the entire facial region (Figs. 254, 255), 




Fig, 256.— Apparatus for Fracture of the Bones of the Face Applied. 

and special precautions should be observed to prevent the patient 
from disturbing the dressing by rubbing his head against sur- 
rounding objects, such as the stall, the manger, the rack, etc. 
Clots of blood in the nasal passages must be washed out, collec- 
tions of pus must be removed from the sinuses, and if the teeth 
ai'e loosened and likely to fall out, they should be removed. If 
roaring is threatened, tracheotomy is indicated. 

Fractures of the Pre-Maxillary Bone. — These are mentioned 
by continental authors. They are usually encountered in connec- 
tion with fractiu'es of the nasal bone, and may take place either 
in the width or length of the bone. 

The deformity of the upper lip, which is drawn sideways in 



232 OPEBATIONS ON BONES. 

this lesion, renders it easy of diagnosis. The abnormal mobihty 
and the crepitation, with the pain manifested by the patient when 
undergoing examination, are concurrent symptoms. Looseness 
of the teeth, abundant saHvation, and entire inability to grasp the 
food complete the symptomatology of these accidents. In the 




Fig. 256.— Fracture of the Lower Jaw. 

treatment, splints of gutta percha or leather are sometimes used, 
but they are of difficult application. Our own judgment and 
practice are in favor of the union of the bones by means of metalhc 
sutures. 

The Zioioer Jaw. — A fracture here is not an injury of infrequent 
occurrence. It involves the body of the bone, at its symphysis, or 
back of it, and includes one or both of its branches, either more 
or less forward, or at the posterior part, near the temporo-max- 
illary articulation, at the coronoid process. 

Falls, blows, or other external violence, or powerful muscular 
contractions dur-ing the use of the speculum, may be mentioned 
among the causes of this lesion. The fracture of the neck and of 
the branches in front of the cheeks cause the lower jaw, the true 
dental arch, to drop without the ability to raise it again to the 
upper, and the result is a pecuHar and characteristic physiognomy 
(Fig. 256.) The prehension and mastication of food become im- 
possible; there is an abundant escape of fetid and sometimes 
bloody saliva, especially if the gums have been wounded ; there is 
excessive mobility of the lower end of the jawbone ; and there is 



FEACTUi.ES. 233 




Fig. 257.— Splint for Fracture of the Lower Maxillary. 

crepitation, and frequently paralysis of the under lip. But al- 
though the aspect of an animal suffering with a complete and 
often compound and comminuted fracture of the submaxilla pre- 
sents at times a frightful spectacle, the prognosis of the case is 
comparatively simple, and recovery usually only a question of 
time. The severity of the lesion corresponds in degree vdth that 
of the violence to which it is due, the degree of simphcity or the 
amount of compHcation, and with the situation of the wound. It 
is simple when at the symphysis, but becomes more serious when 
it affects one of the branches, to be again aggravated when both 
are involved. Fracture of the coronoid process becomes import- 
ant principally as an evidence of the existence of a morbid diathe- 
sis, such as osteoporosis, or the like. 

The particular seat of the injury, with its special features, will 
of course determine the treatment. For a simple fracture without 
displacement, provided there is no laceration of the periosteum, 
an ordinary supporting bandage will usually be sufficient. But 
when there is displacement the reduction of the fracture must first 
be accompHshed, and for this special splints are necessary. In a 
fracture of the symphysis or of the branches the adjustment of the 
fragments by securing them with metallic sutures is the first step 
necessary, to be f oUowed by the application of supports, consisting 
of splints of leather or sheets of metal (Fig. 258 and 259), the entire 



234 



OPERATIONS ON BONES. 




Fig. 25S.— Splint, for Fracture of the Branches. 



front of tlie head being then covered with bandages prepared with 
adhesive mixtures. During the entire course of treatment a special 
method of feeding becomes necessary. The inability of the patient 
to appreciate the situation of course necessitates a resort to an 
artificial mode of introducing the necessary food into his stom- 
ach, and it is accomplished by forcing between the commissures 
of the lips, in a liquid form, by means of a syringe, the milk or 




Fig. 259.— Another Splint for Fracture of the Maxillary. 



FKACTUEES. 



235 



nutritive gruels selected for his sustenance, until the consoUdation 
is sufficiently advanced to jjermit the ingestion of food of a more 
soUd consistency. The callus will usually be sufficiently hardened 
in two or three weeks to allow of a change of diet to mashes of 
cut hay and scalded grain, until the removal of the dressing re- 
stores him to his old habit of mastication. 

Fractures of vertehrce. — These are not very common, but when 
they do occur the bones most frequently injured are those of the 
back and loins. The ordinary causes of fractui'e are responsible 
here as elsewhere, such as heavy blows on the sj^inal column, severe 
falls while conveyiag heavy loads, and especially violent efforts in 
resisting the process of casting. Although occurring more or less 
frequently under the latter cii'cumstances, the accident is not always 
attributable to carelessness or error in the management. It may, 
of coiu'se, sometimes result from such a cause as a badly iDrejjared 
bed, or the accidental presence of a hard body concealed in the 
straw, or to a heavy fall when the movements of the patient have 
not been sufficiently controlled by an effective apparatus and its 
skillful adaptation, but it is quite as likely to be caused by the 
violent resistance and the consequent jjowerful muscular contrac- 
tion by the frightened jjatient. The sim- 
ple fact of the overarching of the vertebral 
column, with excessive pressure against 
it from the intestinal mass, owing to the 
spasmodic action of the abdominal mus- 
cles, may account for it, and so also may 
the struggles of the animal to escape from 
the restraint of the hobbles while frantic 
under the pain of an operation without 
anaesthesia. In these cases the fracture 
usually occm-s ia the body or the annular 
part, or both, of the posterior dorsal or 
FiG.360.— Fracture of the Body the anterior lumbar vertebra. When the 
of a Dorsal Vertebra. tranversc processes of the last-named 

bones are injured, it is j)robably in consequence of heavy concus- 
sion incident to striking the ground when cast. Diagnosis of a 
fracture of the body of a vertebra is not always easy, especially 
when quite recent, and more especially when there is no accom- 
panying displacement. There are certain peculiar signs accom- 
panying the occurrence of the accident while an operation is in 




236 



OPEEATIONS ON BONES. 





Fig. 261a.— Comminuted Fracture of a Dor- 
sal Vertetorae at the Annular Portion. 



Fig. 261.— United Fracture of the Spi- 
nous Processes of Dorsal Vertebrae. 

progress which should at once excite the suspicion of the surgeon. 
In the midst of a violent struggle the patient becomes suddenly 
quiet ; the movement of a sharp instrument which at first excited 
his resistance fails to give rise to any further evidence of sensation ; 
perhaps a general trembling, lasting for a few minutes, will f oUow, 
succeeded by a cold, profuse perspiration, particularly between 
the hind legs, and frequently there will be micturition and defe- 
cation. Careful examination of the vertebral column may then 
detect a slight depression or irregularity in the direction of the 
spine, and there may be a diminution or loss of sensation in the 
j)osterior part of the trunk while the anterior portion continues to 
be as sensitive as before. In making an attempt to get ujDon his 
feet, however, upon the removal of the hobbles, only the fore part 
of the body will respond to the effort, a degree of paraplegia being 
present, and while the head, neck, and fore part of the body wiU 
be raised, the hiad quarters and hind legs will remain inert. The 
animal may perhaps succeed in rising and probably may be re- 



FRACTURES. 



237 




Fig. 262. — Fracture of the Axis in an Animal Suffering with OBteo-Porosis. 

moved to his stall, but the displacement of the bone will follow, 
converting the fracture into one of the complete kind, either 
thi'ough the exertion of walking or by a renewed attemj^t to rise 
after another fall, before reaching his stall. By this time the 
paralysis is complete, and the extension of the meningitis which 
has become estabUshed is a consummation soon reached. 

To say that the prognosis of fracture of the body of the vertebrae 
is always serious is to speak very mildly. It were better, perhaps, 
to say that occasionally a case may recover. Fractures of the 
transverse processes are less serious. 

Instead of stating the indication in this class of cases, as if 
assuming them to be medicable, the question naturally becomes 
rather a queiy : " Can any treatment be recommended in a fracture 
of the body of a vertebra?" The only indication in such a case, 
in our opinion, is to reach the true diagnosis in the shortest pos- 
sible time and to act accordingly. If there is displacement, and 
the existence of serious lesions may be inferred from the nervous 
symptoms, the destruction of the suffering animal appears to sug- 
gest itself as the one conclusion in which considerations of policy, 
humanity, and science at once unite. 

If, however, it is fairly evident that no displacement exists; 
that pressure upon the spinal cord is not yet present ; that the 
animal with a little assistance is able to rise ujaon his feet and to 
walk a short distance, it may be well to_ experiment upon the case 
to the extent of placing the j^atient in the most favorable circum- 
stances for recovery, and allow nature to operate without further 
interference. This may be accomplished by securing immobility 



238 OPERATIONS ON BONES. 

of the whole body as much as possible, and especially of the sus- 
pected region, by placing the patient in slings, in a stall sufficiently 
narrow to preclude lateral motion, and covering the loins with a 
thick coat of agglutinative mixture, and wait for developments. 

Fracture of the Ribs. — The different regions of the chest are 
not equally exposed to the violence to which fractiu'es of the ribs 
are due, and they are therefore either more common or more easily 
discovered during life at some points than at others. The more 
exposed regions are the middle and the posterior, while the front 
is largely covered and defended by the shoulder. A single rib 
may be the seat of fracture, or a number may be involved, and 
there may be injuries on both sides of the chest at the same time. 
It may take place lengthwise, in any part of the bone, though the 
middle, being the most exposed, is the most frequently hui-t. In- 
complete fractures are usually lengthwise, involving a portion only 
of the thickness, or one or other of the surfaces. The complete 
kind may be either transverse or obhque, and are most commonly 




Fig. 263.— United Transversal and Longitudinal Fractures of the Ribs. 

denticulated. The fracture may be comminuted, and a single 
bone may show one of the complete and one of the incomplete 
kind at different points. The extent of surface presented by the 
thoracic region, with its complete exposure at all points, explains 
the liabihty of the ribs to suffer from all forms of external vio- 
lence. 

In many instances fractures of these bones continue undiscov- 
ered, especially the incomplete variety, without displacement, 
though the evidences of local pain, a certain amount of swelling 
and a degree of disturbance of the respiration, if noticed during 
the examination of a patient, may suggest a suspicion of their ex- 
istence. Abnormal mobility and crepitation are difficult of de- 
tection, even when j)i"esentj and they are not always present. 



FKACTURES. 239 

Wlien there is displacement the deformity which it occasions "will 
betray the fact, and when such an injury exists the surgeon will, 
of course, become vigilant in view of possible and probable com- 
pHcations of thoracic trouble, and prepare himself for an encoun- 
ter with a case of traumatic pleuritis or pneumonia. Fatal injur- 
ies of the heart are recorded. Subcutaneous emphysema is a 
common accompaniment of broken ribs, and we recall the death 
from this cause of a patient of our own, which had suffered a frac- 
ture of two ribs in the region of the withers under the cartilages 
of the shoulder, and of which the diagnosis was made only after 
the fatal ending of the case. 

These hui'ts are not often of a very serious character, though 
the union is never as solid and complete as in other fractures, the 
callus being usually imperfect and of a fibrous character, with an 
amphiai'thi'osis formation. Still, compHcations occur which may 
impart gravity to the prognosis. 

Fractures with but a sHght or no displacement need no reduc- 
tion. All that is necessary is a simple apj)lication of a bHstering 
nature as a preventive of inflammation or for its subjugation when 
present, and in order to excite an exudation which will tend to 
aid in the support and immobilization of the parts. At times, 
however, a better effect is obtained by the appHcation of a band- 
age placed firmly around the chest, although, while this limits the 
motion of the ribs, it is aj)t to render the respiration more labored. 

If there is displacement with much accompanying pain and 
e\ddent irritation of the lungs, the fracture must be reduced with- 
out delay. The means of effecting this vary according to whether 
the displacement is outward or inward. In the first case the 
bone may be straightened by pressure from without, while in the 
second the end of the bone must be raised by a lever, for the in- 
troduction of which a smaU. incision through the skin and inter- 
costal spaces wiU be necessary. "When coaptation has been af- 
fected it must be retained by the external appUcation of adhesive 
mixture, with spHnts and bandages around the chest. 

Fractures of the bones of the 2^elvis will be considered under 
their separate denominations, as those of the sacrum and the os 
innominata, or the hip, which includes the subdivision of the 
ihum, the pubes, and the ischium. 

The Sacrum. — Fractures of this bone are rarely met with 
among solipeds. Among cattle, however, it is of common occur- 



240 OPERATIONS ON BONES. 

rence, being attributed not only to the usual varieties of violence, 
as blows and other external hurts, but to the act of coition, and 
to violent efforts in parturition. It is generally of the transverse 
kind, and may be recognized by the deformity which it occasions. 
This is due to the dropping of the bone, with a change in its di- 
rection and a lower attachment of the tail, which also becomes 
more or less paralyzed. The natural and spontaneous relief which 
usually interposes in these cases has doubtless been observed by 
the extensive cattle breeders of the West, and their practice and 
example fully establishes the inutility of interference. Still, cases 
may occur in which reduction may be indicated, and it then be- 
comes a matter of no difficulty. It is effected by the introduction of 
a round, smooth piece of wood into the rectum as far as the frag- 
ment of the bone, and using it as a lever, resting it upon another 
as a fulcrum placed under it outside. The bone having been thus 
returned maybe kept in place by the ordinary external means in use. 

The Os Iniiominata. — Fractures of the ilium maybe observed 
either at the angle of the hip or at the neck of the bone ; those of 
the pubes may take place at the symphysis, or in the body of the 
bone ; those of the ischium on the floor of the bone, or at its pos- 
terior external angle. Or, again, the fracture may involve all 
three of these constituent parts of the hip bone by having its situ- 
ation in the articular cavity — the acetabulum by which it joins the 
femur or thigh bone. 

Some of these fractures are easily recognized, while others are 
difficult to identify. The ordinary deformity which characterizes 
a fracture of the external angle of the ihum, its dropping and the 
diminution of that side of the hip in width, unite in indicating the 
existence of the condition expressed by the term "hipped." But 
an incomplete fracture, or one that is complete without displace- 
ment, or even one with displacement, often demands the closest 
scrutiny for its discovery. The lameness may be well marked, and 
an animal may show but little appearance of it while walking, but 
upon being urged into a trot will manifest it more and more, until 
presently he will cease to use the crippled limb altogether, and 
perform his traveling entirely on three legs. The acute character 
of the lameness will vary in degree as the seat of the lesion ap- 
proximates the acetabulum. In walking, the motion at the hip is 
very limited, and the leg is dragged, while at rest it is reUeved 
from bearing its share in sustaining the body. An intelligent 




241 



Fig. S64.— Fractures of the Ossa Innominata : 1, at the external angle; 2, at the 
internal angle; 3, at the neck of the ilium; 4, at the body of the pubis; 4o, at the 
antero-external angle of the ischium ; 5, at the cotyloid cavity ; 6, at the postero-exter- 
nal angle of the ischium ; 7, at the symphysis pubis. 

oj)inion and correct conclusion will depend largely upon a knowl- 
edge of the history of the case, and while in some instances that 
will be but a report of the common etiology of fractvires, such as 
blows, hurts, and other external violence, the simple fact of a fall 
may fui-nish a satisfactory solution of the whole matter. 

With the exception of the deformity of the ilium in a fractiu-e 
of its external angle, and unless there has been a serious laceration 
of tissues and infiltration of blood, or excessive disj)lacement, there 
are no very definite external symptoms in a case of a fractui*e of 
the hip bone. There is one, however, which, in a majority of cases, 
will not fail — it is crepitation. This evidence is attainable by both 
external and internal examination — by manipulation of the gluteal 
surface and by rectal taxis. Very often a lateral motion, or bal- 
ancing of the hinder parts by pressing the body from one side to 
the other, will be sufficient to render the crepitation more distinct 
— a slight sensation of grating, which may be perceived even through 
the thick coating of muscle which covers the bone — and the sensa- 
tion may not only be felt, but to the ear of the expert may even 
become audible. This external manifestation is, however, not 
always sufficient in itself, and should always be associated with the 
rectal taxis for coiToboration. It is true that this may fail to add to 
the evidence of fracture, but till then the simple testimony aJOforded 



242 OPEEATIONS ON BONES. 

by the detection of crepitation from the surface, though a strong 
confirmatory point, is scarcely sufficiently absolute to estabhsh 
more than a reasonable probability or strong suspicion in the case. 

In addition to the fact that the rectal examination brings the 
exjjloring hand of the surgeon into near proximity to the desu-ed 
point of search, and to an accurate knowledge of the situation of 
parts, both pro and con as respects his own views, there is another 
advantage attendant upon it which is well entitled to appreciation. 
This is the facility with which he can avail himself of the co-opera- 
tion of an assistant, who can aid him by manipulating the implicated 
limb and placing it in various positions, so far as the patient will 
permit, while the surgeon himself is making explorations and study- 
ing the effect from within. By this method he can hardly fail to 
ascertain the character of the fracture and the condition of the 
bony ends. By the rectal taxis, as if with eyes in the finger ends, 
he will " see " what is the extent of the fracture of the ilium or of 
the neck of that bone ; to what part of the central portion of the 
bone (the acetabulum) it reaches ; whether this is free from disease 
or not, and in what location on the floor of the pelvis the lesion is 
situated. We have frequently, by this method, been able to detect 
a fracture at the symphysis, which from its history and symptoms 
and an external examination, could only have been guessed at. 

Yet, with all its advantages, the rectal examination is not alwaj's 
necessary, as, for example, when the fracture is at the posterior 
and external angle of the ischium, when by friction of the bony 
ends the surgeon may discern the crepitation without it. 

Every variety of complication, including muscular lacerations 
with the formation of deep abscesses and injuries to the organs 
of the pelvic cavity, the bladder, the rectum, and the uterus, may 
be associated with fractures of the hip bone. 

The prognosis of these lesions will necessarily vary considerably. 
A fracture of the most siiperficial part of the bone of the ilium or 
of the ischium, especially where there is Httle displacement, will 
unite rapidly, leaving a comparatively sound animal often quite 
free from subsequent lameness. But if there is much disjDlacement, 
only a ligamentous union will take place, with much deformity and 
more or less irregularity in the gait. Other fractures may be fol- 
lowed by complete disability of the patient, as, for example, when 
the cotyloid cavity is involved, or when the reparatory process has 
left bony deposits in the pelvic cavity at the seat of the union. 



FEACTUEES. 243 

whicli may, with the female, interfere with the steps of parturition, 
or induce some local paralysis by pressure upon the nerves which 
govern the muscles of the hind legs. This is a condition not in- 
frequently observed when the callus has been formed on the floor 
of the pelvis near the obturator foramen, pressing upon the course 
or involving the obturator nerve. 

The treatment of all fractiu-es of the hip bone should, in our 
estimation, be of the simplest kind. Rendered comparatively im- 
movable by the thickness of the muscles by which the region is 
enveloped, one essential indication suggests itself, and that is, to 
place the animal in a position which, as far as possible, will be fixed 
and permanent. For the accompHshment of this purpose the best 
measure, as we consider it, is to place him in a stall of just suffi- 
cient width to admit him, and to apply a set of slings snugly, but 
comfortably. This will fulfill the essential conditions of recovery, 
rest, and immobihty. Bhstering applications would be injurious, 
though the adhesive mixture might j)rove in some degree beneficial. 

The minimum period allowable for solid union in a fractured 
hip is, in our judgment, two months, and we have known cases 
in which that was too short a time. 

As we have before said, there may be cases in which the 
treatment for fractau'e at the floor of the pelvis has been followed 
by symptoms of partial paralysis, the animal, when lying down, 
being unable to regain his feet, but moving freely when placed in 
an upright position. This condition is due to the interference of 
the caUus with the functions of the obturator nerve, which it 
presses upon or surrounds. We feel warranted by our experience 
in similar cases in cautioning owners of horses in this condition 
to exercise due patience, and to avoid a premature sentence of 
condemnation against their invalid servants ; they are not all irre- 
coverably paralytic. With alternations of moderate exercise, rest in 
the slings, and the effect of time while the natural process of ab- 
sorption is taking effect upon the callus, with other elements of 
change that may be so operating, the horse may in due time be- 
come able to once more earn his subsistence and serve his master. 

Fracture of the Scapula. — This bone is seldom fractured, its 
comparative exemption being due to its free mobHity and the pro- 
tection it receives from the superimposed soft tissues. Only 
direct and powerful causes are sufficient to effect the injury, and 
when it occurs the large rather than the smaller animals are the 



244 



OPEBATIONS ON BONES. 




Fig. 265.— Transverse Fracture of the Scapula. 

subjects. The causes are heavy blows or kicks, and violent 
collisions with unyielding objects. Those which are occasioned 
by faUs are generally at the neck of the bone, and of the trans- 
verse and comminuted varieties. 

The diagnosis is not always easy. The symptoms are inability 
to rest the leg on the ground and to carry weights, and they are 
present in various degrees from slight to severe. The leg rests 
upon the toe and seems shortened, locomotion is performed by 
jumps. Moving the leg while examining it and raising the foot 
for inspection seem to produce much pain and cause the animal 
to rear. Crepitation is readily felt with the hand upon the 
shoulder when the leg is moved. If the fracture occurs in the 
upper part of the bone, overlapping of the fragments and dis- 
placement will be considerable. 

The fracture of this bone is usually classed among the more 
serious accidents, though cases may occur which are foUowed by 
recovery without very serious ultimate results, especially when 
the seat of the injury is at some of the upper angles of the bone, 
or about the acromion crest. But if the neck and the joint are 



FRACTUKES. 



245 




Pig. 266.— Bourgelat Apparatus for Fracture and Dislocation of the Shoulder Joint. 




FIG. S67.— The same in place. 



246 



OPEKATIONS ON BONES. 



the parts involved, complications are apt to be present which are 
likely to disable the animal for life. 

If there is no displacement a simple adhesive dressing, to 
strengthen and immobilize the parts, wiU be sufficient. A coat of 
black pitch dissolved with wax and Venice turpentine, kept in place 
over the region with oakum or Hnen bands, will be all the treat- 
ment required, especially if the animal is kept quiet in the shngs. 

Displacement cannot be remedied, and reduction is next to 
impossible. Sometimes an iron plate is applied over the parts 
and retained by bandages, as in the dressing of Bourgelat (Figs. 
266, 267) ; and this may be advantageously replaced by a pad of 
thick leather. In smaller animals, and also in larger ones, the 
parts are retained by figure-8 bandages, embracing both the nor- 
mal and the diseased shoulders, crossing each other in the axilla 
and covered with a coatinsr of adhesive mixture. 





Fig. 268.— Delwart's Bandage for 
Fracture of the Scapula. 



Fig. 269.— Another Bandage, 
with Iron Splints. 



Fractures of the Humerus. — These are more common in small 
than in large animals, and are always the result of external trau- 
matism. They are generally very oblique, are often comminuted, 
and though more usually involving the shaft of the bone will in 
some cases extend to the upper end and into the articular head. 
There is ordinarily considerable displacement in consequence of 



FEACTURES. 



247 



the overlapping of the broken ends of the bone, and this, of 
course, causes more or less shortening of the hmb. There will 
also be swelling, with difficulty of locomotion, and crepitation will 
be easy of detection. This fracture is always a serious damage 
to the patient, leaving him with a permanently shortened limb 
and a remediless, lifelong lameness. 

If treatment is determined upon, it will consist in the reduction 
of the fracture by means of extension and counter extension, and 
in order to accomplish this the animal must be thrown. If suc- 
cessful in the reduction, then follows the application and adjust- 





FlG. 270.— Commlnutd Frac- 
ture of theHumerus. 



Fig. 271.— Oblique Fracture of the Humerus 
with Displacement and Partial Union. 



ment of the apparatus of retention, which must needs be of the 
most perfect and efficient kind. And finally, this, however skill- 
fully contrived and carefully adapted, will often fail to effect any 
good purpose whatever. 

Fracture of the Forearm. — A fracture in this region may also 
involve the radius or the cubitus, the first being broken at times 
in its upper portion above the radio-cubital arch at the olecranon. 
If the fracture occurs at any part of the forearm from the radio- 



248 



OPERATIONS ON BONES. 



cubital arch down to the knee, it may involve either the radius 
alone or the radius and the cubitus, which there intimately imite. 
Besides having the same etiology with most of the fractures, 
those of the forearm are, nevertheless, more commonly due to 
kicks from other animals, especially when crowded together in 
large numbers in insufficient space. It is a matter of observation 
that, under these circumstances, fractures of the incomplete kind 





Pig, 271a.— Consolidated Frac- 
of the Body of the Humerus. 



Pig. 272. 
Fractures of the Radius. 



are those which occur on the inside of the leg, the bone being in 
that region almost entirely subcutaneous, while those of the com- 
plete class are either oblique or transverse. The least common 
are the longitudinal, in the long axis of the bone. 

This variety of fracture is easily recognized by the appearance 
of the leg and the different changes it undergoes. There is 
inability to use the limb; impossibihty of locomotion; mobility 



FRACTURES. 249 




Fig. 273.— Fracture of the Ulna. 

below tlie injury ; the ready detection of crepitation — in a word, 
tlie assemblage of all the signs and symptoms which have been 
already considered as associated with the history of broken bones. 

The fracture of the cubitus alone, princiiially above the radio- 
cubital ai'ch, may be ascertained by the aggravated lameness, the 
excessive soreness on pressvire, and perhaps a certain increase of 
motion, with a very slight crepitation if tested for in the usual 
way. Displacement is not likely to take place except when it is 
well up towards the olecranon or its tuberosity, the upper seg- 
ment of the bone being in that case likely to be drawn upward. 
For a simple fracture of this region there exists a fair chance of 
recovery, but in a case of the compound and comminuted class 
there is less ground for a favorable prognosis, especially if the 
elbow joiat has suffered injury. A fracture of the cubitus alone 
is not of serious importance, except when the same conditions 
prevail. A fracture of the olecranon is less amenable to treat- 
ment, and promises little better than a ligamentous union. 

Considering all the various conditions iavolving the nature and 
extent of these lesions, the position and direction of tlie bones 
of the forearm are such as to render the chances for recovery from 
fracture as among the best. The reduction, by extension and 



250 



OPERATIONS ON BONES. 



counter-extension; the maintenance of the coaptation of the seg- 
ments; the adaptation of the dressing by splints, oakum, and 
agglutinative mixtures ; in a word, all the details of treatment may 
be here fulfilled with a degree of facility and precision not attain- 
able in any other part of the organism. An important if not an 
essential point, however, must be emphasized in regard to the 
splints. ^Vhether these are of metal, wood, or other material, they 
should reach from the elbow joint to the groxind, and should be 
placed on the posterior face and on both sides of the leg. This is 
then to be so confined in a properly construct- 
ed box as to preclude all possibility of motion, 
while yet it must sustain a certain portion of 
the weight of the body. The iron spHnt rec- 
ommended by Bourgelat is designed for frac- 
tures of the forearm, of the knee, and of the 
cannon bone, and wall prove to be an appliance 
of great value. For small animals our prefer- 
ence is for an external covering of gutta per- 
cha, embracing the entire leg. A sheet of this 
substance of suitable thickness, according to 
the size of the animal, softened in lukewarm 
water, is, when sufficiently pliable, molded on 
the outside of the leg, and when suddenly 
hardened by the application of cold water 
forms a complete casing sufficiently rigid to 
resist all motion. Patients treated in this 
manner have been able to use the limb freely, 
without pain, immediately after the application iron Spiint for Fracture 
of the dressing. The removal of the splint is ^""^ Lugation of the 

Forearm. 

easily effected by cutting it away, either wholly 

or in sections, after softening it by immersing the leg in a warm 

bath. 

Fracture of the Knee. — This accident, happily, is of rare occur- 
rence, but when it takes place is of a severe character, being of the 
comminuted kind, and always accompanied by synovitis, with dis- 
ease of the joint, requiring for treatment therefor, besides the in- 
dication of perfect immobihty of the joint, that of open joints, 
synovitis, and arthritis. 

Fracture of the Femur. — The protection which this bone re- 
ceives from the large mass of muscles in which it is enveloped does 




Fig. 274. — Bourgelat'B 



FRACTURES. 



251 



not suffice to invest it with immunity in regard to fractures. It 
contributes its share to the hst of accidents of this description, 
sometimes in consequence of external violence and sometimes as 
the result of muscular contraction ; sometimes it takes place at 
the upper extremity of the boue; sometimes at the lower; some- 
times at the head, when the condyles become implicated; but it is 
principally found in the body or diaphysis. The fractiu-e may be 
of any of the ordinary forms, simple or compound, complete or in- 
complete, transverse or oblique, etc. A case of the comminuted 
variety is recorded in which eighty-five fragments of bone were 
counted and removed. 

The thickness of the muscular covering sometimes renders the 
diagnosis difficult by interfering with the manipulation, but the 
crepitation test is readily available even when the swelhng is con- 
siderable and which is likely to be the case as the result of the in- 





FlG. 275.— Fracture of the Femiir. 



Fig. 276.— Fracture, with Shortening. 



252 OPERATIONS ON BONES. 

terstitial hemorrhage which naturally follows the laceration of the 
blood vessels of the region involved. If the f ractm-e is at the neck 
of the bone the muscles of that region (the gluteal) are firmly con- 
tracted and the leg seems to be shortened in consequence. Loco- 
motion is impossible. Crepitation may in some cases be discerned 
by rectal examination, with one hand resting over the coxo femoral 
articulation. Fractures of the tuberosities of the upper end of 
the bone, the great trochanter, may be identified by the deform- 
ity, the swelling, the impossibiUty of rotation, and the dragging 
of the leg in walking. Fracture of the body is always accompanied 
by displacement, and as a consequence a shortening of the leg, 
which is carried forward. The lameness is excessive, the foot 
being moved, both when raising it from the ground and when 
setting it down, very timidly and cautiously. " The manipulations 
for the discovery of crepitation always cause much pain. Lesions 
of the lower end of the bone are more difficult to diagnosticate 
with certainty, though the manifestation of pain while making 
heavy pressure upon the condyles will be so marked that only 
crepitation will be needed to turn a suspicion into a certainty. 

The question as to treatment in fractures of this description 
resolves itself into the query whether any treatment can be sug- 
gested that can avail anything practically as a curative measure, 
whether, upon the hypothesis of reduction as an accomplished fact, 
any permanent or efficient device as a means of retention is within 
the scope of human ingenuity. If the reduction were successfully 
performed would it be possible to keep the parts in place by any 
known means at our disposal? At the best the most favorable 
result that could be anticipated would be a reunion of the fragments, 
with a considerable shortening of the bone, and a helpless, limp- 
ing, crippled animal to remind us that for human achievement 
there is a "thus far, and no farther." 

In small animals, however, attempts at treatment are justifiable, 
and we are convinced that in many cases of difficulty in the appli- 
cation of splints and bandages a patient may be placed in a con- 
dition of undisturbed quiet and left to the processes of nature for 
"treatment " as safely and with as good an assurance of a favorable 
result as if he had been subjected to the most heroic secundum 
artem doctoring known to science. As a case in point, we may 
mention the case of a pregnant bitch which sufi'ered a fracture of 
the upper end of the femur by being run over by a light wagon. 



FRACTURES. 253 

Her " treatment " consisted in being tied up in a large box and 
let alone. In due time she was delivered of a family of puppies, 
and in three weeks she was ronning in the streets, Umping very 
sHghtly, and nothing the worse for her accident. 

Fracture of the Patella. — This, fortunately, is a rare accident 
and can only result from direct violence, as a kick or other blow. 
The lameness which follows it is accompanied with enormous 
tumefaction of the joint and disease of the articulation. The prog- 
nosis is unavoidably adverse, destruction being the only termi- 
nation of an incurable and very painful injury. 

Fractures of the Tibia are probably more frequently encoun- 
tered than any others among the class of accidents we are consid- 
ering. As with injuries of the forearm of a Uke character, they 
may be complete or incomplete; the former when the bone is 
broken in the middle or at the extremities, and transverse, oblique, 
or longitudinal. The incomplete kind are more common in this 
bone than in any other. 

Complete fractures are easy to recognize, either with or -without 
displacement. The animal is very lame, and the leg is either 
dragged or held up clear from the ground by flexion at the stifle, 
while the lower part hangs down. Carrying weight or moving 
backward is impossible. There is excessive mobility below the 
fracture and well-marked crepitation. If there is much displace- 
ment, as in an oblique fracture, there will be considerable short- 
ening of the leg. 

While incomplete fractures cannot be recognized in the tibia 
with any greater degree of certauity than in any other bone, there 
are some facts associated with them by which a diagnosis may be 
justified. The hypothetical history of a case may serve as an 
illustration : 

An animal has received an injui-y by a blow or a kick on the 
inside of the bone, perhaps without showing any mark. Becoming 
very lame immediately afterwards, he is allowed a few days' rest. 
Being then taken out again, he seems to have recovered his sound- 
ness, but within a day or two, or even in a shorter time, he be- 
trays a little soreness, and this increasLag he becomes very lame 
again, to be furloughed once more, with the result of a temporary 
improvement, and again a return to labor and again a relapse of 
the lameness ; and this alternation seems to be the rule. The leg 
being now carefuUy examined, a local periostitis is readily discov- 



254 



OPEKATIONS ON BONES. 





Fig. 2' 



, — Fracture of the 
Tibia. 



Fig. 278.— Bourgelat'B Iron Splint for 
Fractured Tibia. 



ered at the jjoint of the injury, the part being warm, swollen, and 
painful. What further proof is necessary ? Is it not evident that 
a fracture has occurred, first superficial — a mere split in the bony 
structure which, fortunately, has been discovered before some 
extra exertion or a casual misstep had developed it into one of the 
complete kind, possibly with complications? What other infer- 
ence can such a series of symptoms thus repeated establish? 

The prognosis of fracture of the tibia must, as a rule, be un- 
favorable. The difficulty of obtaining a union without shortening 
and consequently without lameness, is proof of the futility of or- 
dinary attempts at treatment. But though this may be true in 
respect to fractures of the complete kind, it is not necessarily so 
with the incomplete variety, and with this class the simple treat- 
ment of the slings is all that is necessary to secure consolidation. 
A few weeks of this confinement wiU be sufficient. 

With dogs and other small animals, there are cases which may 
be successfully treated. If the necessary dressings can be success- 
fully applied and retained, a recovery will follow. 



FRACTUKES. 



255 



Fractures of the Hock. — Injuries of the astragalus have been 
recorded which had a fatal termination. Fractures of the os calcis 
have also been observed, but never with a favorable prognosis, and 
attempts to induce recovery have, as might have been anticipated, 
proved futile. 

Fractures of the Cannon Bones. — "Whether these occur in the 
fore or hind legs they appear either in the body or near their ex- 
tremities. If in the body, as a rule the three metacarpal or meta- 
tarsal are also affected, and the fracture is generally transverse 
and oblique, and often compound, one of the segments protruding 
sharply through the skin. Having only the skin for a covering the 
diagnosis is easy. There is no displacement, but excessive mo- 




PiG. 279.— Splint and Dressing for Fractured Cannon Bone. 



256 



OPERATIONS ON BONES. 



bility, crepitation, inability to sustain weiglit, and the leg is kept 
off the ground by the flexion of the upper joint. 

No region of the body affords better f acihties for the appHcation 
of treatment, and the prognosis is, on this account, usually favor- 
able. We recall a case, however, which proved fatal, though under 
exceptional circumstances. The patient was a valuable staUion of 
highly nervous organization, with a compound fracture of one of 
the cannon bones, and his unconquerable resistance to treatment, 
excited by the intense pain of the wound, precluded aU chance of 
recovery, and ultimately caused his death from nervous fever. 

The general form of treatment for these lesions will not differ 
from that which has been already indicated for other fractures. 
Reduction, sometimes necessitating the casting of the patient; 
coaptation, comparatively easy by reason of the subcutaneous sit- 
uation of the bone ; retention, by means of splints and bandages 
— apphed on both sides of the region, and reaching to the ground 
as in fractures of the forearm — these are always indicated. We 
have obtained excellent results by the use of a mold of thick gutta 
percha, composed of two sections and made to surround the entire 
lower part of the leg as in an inflexible case. 

Fracture of the first Phalanx. — The hinder extremity is more 
liable than the fore to this injury. It is usually the result of a 





Fig. 280 Splint and Dressing 

on Lower Part of Fore Leg. 



Fig. 281.— Bourgelat's Splint for Frac- 
ture of the Cannon and Phalanges. 



FRACTURES. 



257 




Fig. 282 

Longitudinal Fractures of 

the Os Suffraginis. 



Fig. 283. 

Comminuted Fracture of the 

Oa Suffraginis. 



violent effort, or of a sudden misstep or twisting of tte leg, and 
may be transverse, or, as has usually been the case in our experi- 
ence, longitudinal (Fig. 282), extending from the upper articular 
surface down to the centre of the bone and generally obhque and 
often comminuted (Fig. 283). The symptoms are the swelling 
and tenderness of the region, possibly crepitation; a certain ab- 
normal mobihty; an excessive degree of lameness, and in some 
instances a dropping back of the fetlock, with perhaps a straight- 
ened or upright condition of the pastern. 

The difficulty of reduction and coaptation in this accident, and 
the probability of bony deposits, as of ringbones, resulting in 
lameness, are circumstances which tend to discourage a favorable 
prognosis. 

The treatment is that which has been recommended for all 
fractures, as far as it can be applied. The iron splint of figure 
281 gives excellent results in many instances, but if the fracture is 
incomplete and without displacement a form of treatment less 
energetic and severe should be attempted. One case is within 
our knowledge in which the owner of an injured horse lost his 
property by his refusal to subject the animal to treatment, the 
post mortem revealing only a simple fracture with very slight dis- 
placement. 



258 



OPEKATIONS ON BONES. 



Fractures of the Coronet. — Though these are generally of the 
comminuted kind, there are often conditions associated with 
them which justify the surgeon in attempting their treatment. 
Though crepitation is not always easy to detect, the excessive 
lameness, the soreness on pressure, the inability to carry weight, 
the difficulty experienced in raising the foot, all these suggest, as 
the solution of the question of diagnosis, the fracture of the 
coronet, with the accompanying realization of the fact that there 
is yet, by reason of the situation of the member, immobilized as it 
is by its structure and its surroundings, room left for a not un- 
favorable prognosis. Only a slight manipulation will be needed 
in the treatment of this lesion. To render the immobility of the 







Fig. 284. 



-Animal with Fracture below the knee with Spinte and Support, 
Resting in Slings. 



FBACTURES. 259 

region more fixed, to support the bones in their position by band- 
aging, and to estabHsh forced immobiLity of the entire body 
with the sUngs is usually all that is required. Ringbone, being 
a common sequela of the reparative process, must receive due at- 
tention subsequently. One of the severest complications likely to 
be encountered is anchylosis. 

Fractures of the Os pedis. — Though these lesions are not of 
very rare occurrence their recognition is not easy, and there is 
more of speculation than of certainty pertaining to their diagnosis. 
The animal is very lame, and, as much as possible, spares the in- 
jured foot, sometimes resting it upon the toe alone and sometimes 
not at all. The foot is very tender, and the exploring pincers of 
the examining sui'geon causes much pain. There is nothing to 
encourage a favorable prognosis, and a not unusual termination 
is an anchylosis with either the navicular bone or the coronet. 

No method of treatment needs to be suggested here, the hoof 
performing the office of retention unaided. Local treatment by 
baths and fomentations will do the rest. It may be months 
before there is any mitigation of the lameness. 

Fracture of the Sesamoid Bones. — This lesion has been con- 
sidered by veterinarians, erroneously, we think, one of rare oc- 
currence. We believe it to be more frequent than has been sup- 
posed. Many observations and careful dissections have convinced 
us that fractures of these little bones have often been mistaken 
for specific lesions of the numerous ligaments that are implanted 
upon their superior and inferior parts, and which have been de- 
scribed as a "giving way" or "breaking down" of these Hga- 
ments. In our ji^osi mortem examinations we have always noted 
the fact that when the attachments of the ligaments were torn 
from then- bony connections minute fragments of bony structure 
were also separated, though we have failed to detect any diseased 
process of the fibrous tissue composing the Ugamentous substance. 

From whatever cause this lesion may arise, it can hardly be 
considered as of a traumatic natvire, no external violence having 
any apparent agency in producing it, and it is our belief that it is 
due to a peculiar degeneration or softening of the bones them- 
selves, a theory which acquires plausibility from the consideration 
of the spongy consistency of the sesamoids. The disease is a 
pecuHar one, and the suddenness with which difi'erent feet are 
successively attacked, at short intervals and without any obvious 



260 . OPERATIONS ON BONES. 

cause, seems to prove the existence of some latent morbid cause 
whicli has been unsusi^ectedly incubating. It is not peculiar to 
any particular class of horses, nor to any special season of the 
year, having fallen under our observation in each of the four 
seasons. The general fact is reported in the history of a majority 
of cases that it makes its appearance without premonition in 
animals which, after enjoying a considerable period of rest, are 
first exercised or put to work, though in point of fact it may 
manifest itself while the horse is still idle in his stable. A 
hyj)othetical case, in illustration, will explain our theory. 

An animal which has been at rest in his stable is taken out to 
work and it will be presently noticed that there is something un- 




FlG. 285.— Fracture of Os Sesamoids. 

usual in his movement. His gait is changed, and he travels with 
short, mincing steps, without any of his accustomed ease and free- 
dom. This may continue until his return to the stable, and then, 
after being placed in his stall, he will be noticed shifting his 
weight from side to side and from one leg to another, continuing 
the movement until rupture of the bony structure takes place. 
But it may happen that the lameness in one or more of the ex- 
tremities, anterior or posterior, suddenly increases, and it be- 
comes evident that the rupture has taken place in consequence of 
a misstep or a stumble while the horse was at work. Then, upon 
coming to a standstill, he vsdll be found with one or more of his 



FRACTURES. 261 

toes turned up — he is unable to place tlie affected foot flat on the 
ground. The fetlock has dropped and the leg rests upon this 
part, the skin of which may have remained intact or may have 
been more or less extensively lacerated. It seldom happens that 
more than one toe at a time wUl turn up, yet stUl the lesion in one 
will be followed by its occurrence in another. Commonly two 
feet of a biped, the anterior or posterior, are affected, and we re- 
call one case in which the two fore and one of the hind legs were 
included at the same time. The accident, however, is quite as 
likely to happen while the horse is at rest in his stall, and he may 
be found in the morning standing on his fetlocks. One of the 
earhest of the cases occurring in oiu' own experience had been 
under oui- care for several weeks for suspected disease of the fet- 
locks, the nature of which had not been made out, when, appar- 
ently improved by the treatment which he had undergone, the 
patient was taken out of the stable to be walked a short distance 
into the country, but had little more than started when he was 
called to a halt by the fracture of the sesamoids of both fore legs. 

While there are no positive premonitory symptoms known of 
these fractures we believe that there are signs and symptoms 
which come but little short of being so, and the appearance of 
which will always justify a strong suspicion of the truth of the 
case. These have been indicated when referring to the soreness 
in standing, the short "mincing" gait, and the tenderness be- 
trayed when pressure is made over the sesamoids on the sides of 
the fetlock, with others less tangible and definable. 

These injuries can never be accounted less than serious, and 
in our judgment will never be other than fatal. If oiu' theory of 
their pathology is the correct one, and the cause of the lesions is 
truly the softening of the sesamoidal bony structure and inde- 
pendent of any changes in the ligamentous fibers, the possibihty 
of a solid osseous union can hardly be considered admissible. 

In respect to the treatment to be recommended and instituted 
it can only be employed with any rational hope of benefit during 
the incubation, and with the anticipatory pvirpose of prevention. 
It must be suggested by a suspicion of the verities of the case, 
and applied before any rupture has taken place. To prevent this 
and to antagonize the causes which might precipitate the final 
catastrophe — the elevation of the toes — resort must be had to the 
slings and to the application of firm bandages or splints, perhaps 



262 OPERATIONS ON BONES. 

of plaster of Paris, with a liigh shoe, as about the only indications 
which science and nature are able to offer. When the fracture is 
an occurred event, and the toes, one or more, are turned up, any 
further resort to treatment will be futile. 

DISLOCATIONS. 

Strength and soUdity are so combined in the formation of the 
joints of our large animals that dislocations or luxations are inju- 
ries which are but rarely encountered. They are met with but 
seldom in cattle and less so in horses, while dogs and smaller 
animals are more often the sufferers. 

The accident of a luxation or (its synonym) dislocation (dis- 
placement) is less often encountered in the animal races than 
in man. This is not because the former are less subject to oc- 
casional violence involving powerful muscular contractions, or are 
less often exposed to casualties similar to those which result in 
luxations in the human skeleton, but because it requires the co- 
operation of conditions, anatomical, physiological, and perhaps 
mechanical, present in one of the races and lacking in the other, 
but which can not in every case be clearly defined. Perhaps the 
greater relative length of the bony levers in the human formation 
may constitute a cause of the difference. 

Among the predisposing causes in animals, caries of articular 
surfaces, articular abscesses, excessive dropsical conditions, de- 
generative softening of the ligaments, and any excessive laxity of 
the soft structures, may be enumerated. 

The symptoms of fractures and of dislocations are not always 
so variant as to preclude the possibility of error in determining a 
case without a thorough examination, but the essential difference, 
as it must always exist, must always be discoverable. 

In a dislocation there is one very pecuhar and characteristic 
feature in the impossibility of motion associated with an excessive 
liberty of movement — the impossibiUty of active or controlled 
motion, and a facility of passive movement (or movableness) at 
either the affected joint or at another of the same leg near to it. 
In a dislocation of the scapulo-humeral (or shoulder) joint the 
animal possesses no power of motion over the limb — no muscular 
contraction can avail to cause it to perform its various functions 
—but in the hands of the surgeon it may be made to describe a 



DISLOCATIONS. 263 

series of movements which would be simply impossible with the 
joint in a state of integrity. Both fractures and luxations are 
marked by deformity, but while in a fracture with displacement 
there will usually be a shortening of the leg, a dislocation may be 
accompanied by either a shortening or a lengthening. Swelling 
of the parts is usually a well-defined feature of these injuries. 

With all this similarity in the symptomatology of luxations 
and fractures, there is one sign which either by its presence or its 
absence will greatly assist in settling a case of differential diag- 
nosis, and this is the existence or lack of crepitation. It has no 
place or cause in a mere dislocation ; it belongs to a fracture, if it 
is a complete one. If there is crepitation with a dislocation then 
it proves that there is a fracture also. 

The prognosis of a luxation is comparatively less serious than 
that of a fracture, though at times the indications of treatment 
may prove to be so difficult to apply that compHcations may ax'ise 
of a very severe character. 

The treatment of luxations must of course be similar to that 
of fractures. Eeduction, naturally, will be the first indication in 
both cases, and the retention of the replaced parts must follow. 
The reduction involves the same steps of extension and counter- 
extension performed in the same manner, with the patient subdued 
by anesthetics. 

The difference between the reduction of a dislocation and that 
of a fracture consists in the fact that in the former the object is 
simply to restore the bones to their true normal position, with 
each articular surface in exact contact with its companion surface, 
the apparatus necessary afterwards to keep them in situ being 
similar to that which is employed in fracture cases, and which will 
usually require to be retained for a period of from forty to fifty 
days, if not longer, before the ruptured retaining hgaments ai'e suffi- 
ciently firm to be trusted to perform their office unassisted. A vari- 
ety of manipulations are to be employed by the surgeon, consisting 
in pushing, pulling, pressing, rotating, and indeed whatever move- 
ment may be necessary, until the bones are forced into such rela- 
tive positions that the muscular contraction, operating in just the 
right directions, puUs the opposite matched ends together in true 
coaptation, a head into a cavity, an articular eminence into a 
trochlea, as the case may be. The " setting " is accompanied by a 



264 OPERATIONS ON BONES. 

peculiar snapping sound, audible and significant, as well as a 
\dsible return of the surface to its normal symmetry. 

Special Dislocations. — While all the articulations of the body 
are liable to this form of injury, there are three in the large animals 
which may claim a special consideration, viz: 

2'he Shoulder Joint. — We mention this displacement without 
intending to imply the practicability of any ordinary attempt at 
treatment, which is usually unsuccessful, the animal whose mishap 
it has been to become a victim to it being disabled for life. The 
superior head of the arm bone, as it is received into the lower 
cavity of the shoulder blade, is so situated as to be liable to be 
forced out of place in four directions. It may escape from its 
socket, according to the manner in which the violence affects 
it, outward, inward, backward, or forward, and the deformity 
which results and the effects which follow wiU correspondingly 
differ. We have said that treatment is generally unsuccessful. 
It may be added that the difficulties which interpose in the way 
of reduction are nearly insurmountable, and that the appHcation 
of means for the retention of the parts after reduction would be 
next to impossible. The prognosis is sufficiently grave from any 
point of view for the luckless animal with a dislocated shoulder. 
The Hip Joint. — This joint partakes very much of the char- 
acteristics of the scapulo-humeral articulation, but is more strongly 
built. The head of the thigh bone is more separated, or promi- 
nent and rounder in form, and the cup-like cavity or socket into 
which it fits is much deeper, forming together a deej), true ball- 
and-socket joint, which is, moreover, re-enforced by two strong 
cords of funicular Ugaments, which unite them together. It will 
be easily comprehended, from this hint of the anatomy of the re- 
gion, that a luxation of the hip joint must be an accident of com- 
paratively rare occurrence. And yet cases are recorded in which 
the head of the bone has been affirmed to slip out of its cavity 
and assume various positions, inward, outward, forward, and back- 
ward. 

The indications of treatment are those of all cases of dislocation. 
When the reduction is accomphshed the surgeon will be apprised 
of the fact by the peculiar snapping sound usually heard on such 
occasions. 

Pseudo luxations of the Patella. — This is not a true disloca- 
tion. The stifle bone is so peculiarly articulated with the thigh 



DISLOCATIONS. 265 

bone that the means of union are of sufficient sti-ength to resist 
the causes which usually give rise to luxations. Yet there is some- 
times discovered a peculiar pathological state in the hind legs of 
animals, the effect of which is closely to simulate the manifestation 
of many of the general symptoms of dislocations. The peculiar 
pathological condition originates in muscular cramps, the action 
of which is seen in a certain change in the coaptation of the artic- 
ular surfaces of the stifle and thigh bone, resulting in the exhibi- 
tion of a sudden and alarming series of symptoms which have 
suggested the phrase of "stifle out" as a descriptive term. The 
animal so affected stands quietly and firmly in his stall, or per- 
haps with one of his hind legs extended backward, and resists 
every attempt to move him backward, and if urged to move for- 
ward he will either refuse, or comply with a jump, with the toe 
of the disabled leg di-agging on the ground and brought forward 
by a second effort. There is no flexion at the hock and no motion 
at the stifle, while the circular motion of the hip is quite free. The 
leg appears to be much longer than the other, owing to the straight- 
ened position of the thigh bone, which forms almost a straight 
line with the tibia from the hip joint down. The stifle joint is 
motionless, and the motions of all the joints below it are more or 
less interfered with. External examination of the muscles of the 
hip and thigh discovers a certain amount of rigidity, with perhaps 
some soreness, and the stifle bone may be seen projecting more or 
less on the outside and upper part of the joint. 

This state of things may continue for some length of time and 
untn treatment is applied, or it may spontaneously and suddenly 
terminate, leaving everything in its normal condition, but j)erhaps 
to return again. 

Pseudo-dislocation of the patella is likely to occur under many 
of the conditions which cause actual dislocation, and yet it may 
often occur in animals which have not been exposed to the or- 
dinary causes, but which have remained at rest in their stables. 
Sometimes these cases are referred to falls in a slippery stall, or 
perhaps slipping when endeavoring to rise ; sometimes to weakness 
in convalescing patients ; sometimes to lack of tonicity of structure 
and general debility; sometimes to relaxation of tissues from 
want of exercise or use. 

The reduction of these displacements of the patella is not 
usually attended with difficulty. A sudden jerk or spasmodic 



266 OPEKATIONS ON BONES. 

action will often be aU that is required to spring the patella into 
place, when the flexion of the leg at the hock ends the trouble for 
the time. But this is not always sufficient, and a true reduction 
may still be indicated. To effect this the leg must be drawn well 
forward by a rope attached to the lower end, and the patella, 
grasped with the hand, forcibly pushed forward and inward and 
made to slip over the outside border of the trochlea of the femur. 
The bone suddenly slips into position, the excessive rigor of the 
leg ceases with a spasmodic jerk, and the animal may walk or trot 
away without suspicion of lameness. But though this may end 
the trouble for the time, and the restoration seem to be perfect 
and permanent, a repetition of the entire transaction may subse- 
quently take place, and perhaps from the loss of some portion of 
tensile power which would naturally follow the original attack in 
the muscles involved, the lesion might become a habitual weakness- 
Warm fomentations and douches with cold water will often 
promote permanent recovery, and Hberty in a box-stall or in the 
field will in many cases insure constant relief. The use of a high- 
heeled shoe is recommended by European veterinarians. The use 
of stimulating liniments, with frictions, charges or even severe 
blisters, may be resorted to in order to prevent the repetition of 
the difficulty by strengthening and toning up the parts. 

AMPUTATIONS. 

To amputate is simply to cxtt off. In veterinary surgery it 
comprehends the removal from the body of an animal of one or 
more of its projecting parts, as a portion of a leg, or an entire ex- 
tremity; the horns, the ears, the penis, the tail, etc. From the 
nature of the case it involves a degree of deformity, greater or less, 
with a loss of the function of the severed member. 

The difference between amputation and extirj)ation has respect 
only to the organs or members which become subject to the opera- 
tion. The parts already referred to are amputated ; the organs or 
members liable to extirpation have their seat in the interior regions, 
as the testicles, the ovaries, and even the uterus, in females, and 
any other non-vital organs or morbid growths, including some of 
the glandular structures, more particularly the lymphatic. 

Amputations in domestic animals are of two classes : In one 
case they are performed at the dictate of a capricious fashion, for 



AMPUTATIONS. 



267 



the alleged purpose of improving the appearance of the animal, 
and are performed upon parts of only secondary and accessory 
functional importance, and which may be removed almost with im- 
punity, as the ears, the tail or the horns. 

In the second class, the subject is brought under the general 
laws governing diseases and remedies, and they are practiced only 
as it becomes necessary by the existence of diseased conditions in 
important organs, such as the penis, the tongue and the locomotory 
organs. In this class the serious nature of the operation must be 
measured by the importance of the function fulfilled by the organ 
impUcated. 

The instruments necessary for the operation are amputating 
knives, similar to those used in human surgery, or more commonly 
those belonging to our veterinary work, a strong, convex bistoury, 





Figs. 286, 287.— Amputating Knives. 




Fig. 288.— Amputating Saw. 

which is generally sufficient, an amputating saw, means of tem- 
porary hemostasis, cord, an elastic band or ligature, needles, 
sutures and artery and dissecting forceps. 

For dressings, balls and pads of oakum of various sizes, com- 
presses and antiseptic washes are needed. 

In the present chapter we shall limit our consideration to the 
amputation of the legs, the horns and the ears. 



268 operations on bones. 

Amputation of Members or Limbs. 

The amputation of the Hmbs of animals is a matter of much 
less importance than a similar mutilation would be in human sur- 
gery, and its occurrence is relatively much less frequent, being 
necessarily limited by the exclusion of that large class of subjects 
whose usefulness would necessarily be lost by the total impairment 
of their organs of locomotion, thus rendered unfit for their work, 
and even when it is indicated for animals designed for food con- 
sumption, the question becoming pertinent whether it would not 
be wiser and more profitable, in a large majority of cases, as it 
would unquestionably be more humane, to dehver them at once to 
the butcher, before subjecting them to a painful mutilation which 
must necessarily more or less impair their condition, and therefore 
materially diminish their market value. 

As a matter of fact, it is principally upon dogs that, in ordinary 
circumstances, the veterinarian is called to operate in this manner, 
as even in his mutilated condition, he may continue to be able to 
fulfil many of his duties as one of the domestic animals. But stiU 
there are circumstances in respect to animals other than the dog, 
under which the operation may be indicated and rationally prac- 
ticed, as when the life of a valuable animal is to be saved on account 
of his desu-able qualities as a breeder, and which may not be dis- 
abled from his special function by the lack of a limb. A valuable 
ram or bull, a high-bred ewe or cow, or perhaps also a mare or a 
stalHon, may, for such a reason, become proper subjects for an 
amputation. 

But even under these conditions, other considerations of impor- 
tance must not be overlooked, and whether it is a fore or a hind 
leg which must be sacrificed, will be a point of great weight to be 
considered in deciding for or against the operation. A female 
with only three legs may yet carry a foetus to term, and be fat- 
tened and put in good condition before being sold for meat, or 
may possibly be covered by a male ; but it would be impossible 
for the stalhon or the bull, deprived of one of his hind quarters, to 
mount and keep the raised position a sufficient time to complete 
the act of copulation. 

Animals of small size and weight, being more supple and active 
in their movements, suffer least from the loss of one of their limbs. 
The distance from the mass of the body to the seat of the ampu- 



AMPUTATIONS. 269 

tation is also a consideration of moment. A reference to all the 
reasons will necessarily prove that of all domesticated animals, 
the horse is probably the one upon which the operation is least 
justifiable. If ever to be performed upon him, it can only be upon 
the lower regions of the leg close to the ground, inasmuch as the 
shortened leg can still be made useful as an apparatus of support, 
either directly or indii'ectly, by artificial means. 

The sum of the matter seems to be embodied in the following 
general considerations pertaining to the question of the amputa- 
tion of the limbs of our domestic animals : 

1st. In Dogs it is indicated in diseases of both bones and soft 
parts, as in comminuted fractures, comphcated with contused 
wounds of the skin or other soft strictures ; in old caries, com- 
phcated with suppurative arthritis ; in osteo-sarcoma ; in the 
crushing of muscular tissues around bones and then- complete 
separation ; in extensive gangrene, as that resulting from the ap- 
pUcation of too tight a bandage ; in chronic suppurative articular 
disease ; in sloughs of soft tissues surrounding the exposed bones ; 
and in deep cancerous affections. 

2d. In O vines. — Indications are offered, as in dogs, in com- 
minuted fractures, with lacerations of soft tissues, and more com- 
monly in comphcated phalangeal arthritis. 

3d. In Bovines. — The same conditions exist as in the smaller 
ruminants. 

4th. In Equines. — Amputation is indicated as a means of 
sa\ing an animal for breeding purposes ; in comphcated fractures 
of the cannon bone, or of the phalanges ; in gangrene of the digital 
organs; extensive abscesses of the same region, with softening of 
tendons, and in suppurative arthritis. It is also sometimes per- 
formed for the removal of a supplementary limb. 

5th. In Birds. — The amputation of a wing or even of a leg 
can be performed, either to prevent flight, or to reHeve a diseased 
process of the limb. 

But in all cases it should be performed upon healthy tissues, 
above the seat of the disease, and at the greatest, possible distance 
from the trunk. 

The number of cases on record is not large, and they are prin- 
cipally reported in European veterinary journals. In these we 
find a case of amputation at the hock in a ewe, by Chabert ; in a 
cow at the knee, by Chaumontel; in an ox of one of the toes, by 



270 OPERATIONS ON BONES. 

Durant ; in a dog at the arm, by Fromage de Feugre ; in a sheep, 
in a case of foot rot, by Lecoq; in a mare at the fetlock, by 
Maurette ; in a stallion, on the third phalanx, by Bouley ; and in 
English journals: in a cow in the metacarjDal region, by Laing; a 
cow on the hind cannon, by Shield ; and on a mare in this coimtiy, 
by Huidekoper. Others are reported, which were attended by vari- 
ous degrees of success, many of them, however, terminating fatally. 

The proper mode of performing the operation is to secure the 
animal in the decubital position, and to place him under the influ- 
ence of general anesthesia, securing temporary hemostasis, by the 
application of the circular Ugature, or a bandage tightly placed 
above the point of amputation, or, preferably, by using the process 
of Esmarch, which secures a more perfect removal of the blood, 
and enables the operator to perform a thoroughly bloodless opera- 
tion. Digital pressure, sometimes recommended for the smaller 
animals, will not, however, secure as good a result as that obtained 
by the ch'cular ligature. 

The operation is made in two ways : first, in the continuity of 
the bones, or by the division of the substance of the bone itself ; 
and second, in their contiguity, or at the nearest sound articula- 
tion. This last is also called disarticulation. 

All amputations consist of three steps : The division of the 
soft tissues, that of the bones, and the arrest or prevention of 
hemorrhage. 

7'Ae First Step, the Division of the Soft Tissues, may be prac- 
ticed several ways, among which the jDrincipal are the circular, 
elliptic and the ovalar methods, and that by flaps ; all of which 
have the common object in view, of leaving a flap of proper form 
and sufficient dimensions to cover the stump of the bone, and 
prevent its projection beyond the surface of the wound. 

The circular method, which is the oldest, consists in incising 
the skin in a circular manner, stretched over the surface of the 
region with the left hand of the operator, or with that of an assist- 
ant. This must be done with rapidity, made by one stroke of the 
knife, applied as perpendicularly over the skin as possible. 

If the amputation is to be made in the continuity of the bones, 
the skin being divided while stretched by the assistant, is sepa- 
rated from its adhesions underneath, and reversed upward ; when 
close to the line where it is yet adherent, the muscles are divided 
circularly, by one stroke of the knife, drawn to the bone. These 



AMPUTATIONS 271 

muscles spontaneously retreat, and the superior stump is drawn 
upward beyond the cutaneous incision. This action may be facil- 
itated bj' separating from the bone whatever attachments may 
exist between them. The periosteum is thus divided, on a level 
with the retracted muscles. 

The amputation in the contiguity of the bones, differs from 
that in the continuity only in the fact that when the section of the 
muscles is made, there is no division of the periosteum necessary, 
and the disarticulation is completed with either the bistoui-y or 
amputating knife, or, in preference, with the sage knife. The 
method hy flaps consists in making on one or both sides of the 
bones, one or two flaps of skin which are afterwards united to 
cover the stump, and form the new surface. 

In amputation by the contiguity of the bone, the method to 
be preferred, and which may be practiced both from within, out- 
ward and contrarywise, is this : In the first instance, the knife is 
passed through the soft tissues at the point where the bone is to 
be separated, and the entire mass divided by drawing the instru- 
ment toward the operator in a somewhat obHque direction. In 
the second way, or from without inward, the flap is first drawn 
with the point of the knife, and then dissected from without, or, 
otherwise, made at once in the same direction, by one stroke of 
the instrument. The flaps must be rounded, not angular, at their 
line of meeting, and in such a way that the amputated wound 
will represent an elliptic inf undibulum, whose center is occupied by 
the stump of the bone, surrounded by whatever projecting fleshy 
structures may be brought over it to form a protective cushion. 

The second step of the operation is that of the section of the 
bone, or of the articular attachments. 

In sawing the bone in its continuity, the periosteum being 
divided, and the soft tissues protected by compresses, some little 
art is necessary. The saw applied perpendicularly to the axis of 
the bone, should be worked slowly at first, until a track is formed, 
after which the movement may be more rapid. PressiU'e upon 
the instrument is unnecessary, if it has been properly set. Special 
caution shoiild be observed in finishing, in order to avoid leaving 
rough edges to be cut off vrith the bone forceps. The saw must 
be propelled wholly by the action of the arm of the surgeon, his 
body remaining completely motionless. 

"When the amputation is made upon the segment of a leg 



272 OPERATIONS ON BONES. 

which has two bones, though they may be divided separately, it 
will be preferable, if they can be held together with sufficient 
firmness, to act upon them jointly, but finishing the smaller bone 
first. 

The actual disarticulation, or second step of the amputation, 
is performed by diA^ding the ligaments or other structures which 
surround the joint, from without inward. Beginning with the 
strongest and most external ligament by giving a movement of 
semi-flexion to the articulation, not necessarily cutting them in 
their middle, the joint is penetrated by inserting the knife be- 
tween the articular surfaces. The double sage knife, according to 
Bouley, is the most convenient. In articulations composed of ir- 
regular surfaces, united by inter-articular ligaments, care must be 
taken to avoid injuring the bones, and to divide the fibrous cords 
only, as most of the synovial capsules must be removed, in order 
to avoid fistulous complications. 

In some disarticulations, according to Bouley, it is necessary 
to use the saw to remove diarthodial projections on the surface of 
the amputated bone, which if left in place would prove a serious 
obstruction to the cicatrization of the stump 

The last step of the operation is the arrest, or, what is better, 
the preve7ition of the hemorrhage. It consists simply in twisting 
or ligating the arterial vessels which have been divided. If the 
means used for the temporary hemostasis prevent the operator 
from discovering its source, the ligatures can be slightly relaxed 
until it is betrayed by the oozing of the blood. The various 
methods of permanent hemostasis have already been considered, 
and need no further description. 

In the application of a dressing to the wound of amputation, 
the requirements are few, but they are imperative, and they are 
sufficient, assuring the best results by their simphcity and solid- 
ity. The soft tissues and the skin must be brought together, 
over the extremity of the bone, and kept together by the apphca- 
tion of a continued suture, leaving a place of drainage for the 
suppuration and the sloughing of the ligatures which occlude the 
blood vessels, and the extremities of these must be gathered to- 
gether at the most dependent part of the wound. This is com- 
pleted and protected by the appHcation of an antiseptic dressing 
consisting of pads of oakum, absorbent cotton, or threads of 
toiirbe, kept in place by rollers, and supported by an outside 



AMPUTATIONS. 



273 



envelope of coarse cloth. The wound may cicatrize by first or by 
second intention, according to the severity of the original injury, 
as well as to the amount of attention bestowed upon the antisep- 
tic applications which may have been employed. 




Fig. 289.— Wooden Leg after Amputation. 

Complications are not uncommon after amputations, though 
they do not materially differ from those which are encountered in 
other serious operations. Among those which may be mentioned 
are: Ist. Secondary hemorrhage, as the result of carelessness in 
the application of the ligatures, which can be overcome, however, 
by immediate or lateral compression, or by the renewal of the lig- 
ature. 2d. Abscesses, of various dimensions, resulting from the 
presence of the hgatures into the wound, or possibly of necrosis 
of the bone. These collections are to be treated in the usual way, 
as are alsa undermining of the ski7i by suppurative collections, 
phlebitis, purulent infection and gangrene, all of these being con- 
ditions having the same indications as in other forms of traumatic 
lesions. 

There are, however, some complications which belong specially 
to the sequelae of this operation, such as may result from an im- 
proper section of the bone, which might end in the formation of 
a conical stump, a condition which, like that of strangidation of 
the stump, can only be relieved by a new amputation, with a bet- 



274 OPEKATIONS ON BONES. 

ter section of the bone, and more careful attention to the subse- 
quent dressing. JV^ecrosis of the amputated bone may also com- 
plicate the process of cicatrization, accompanied by more or less 
pain and difiused suppuration, which cannot be relieved until the 
necrotic bone has sloughed away. 

Amputations in the contiguity of the bones are, besides, likely 
to be complicated with sipiovial ^fistulas, which may be of an ar- 
ticular or tendinous nature. The ordinary forms of treatment in 
similar cases will be sufficient for these. 

These general rules regulate amputations of every kind, though 
the various steps of the operation may have somewhat varied, ac- 
cording to circumstances. But whether it be ux the continuity 
or contiguity of a bone, or whatever may be the bone involved ; 
whether the scapulo-humeral joint, the fetlock or the digital re- 
gion ; or even to remove supplementary digits ; they are of equal 
applicability, and the general modus operandi remains the same. 
Even in the operation of amputation of the wings we find but 
Httle room for modification or change. 

In operating upon the wings of birds, with the principal object 
of destroying their power of flight, it may frequently be accom- 
plished by simply cutting off the extremity of the wing, at the 
carpal articulation, with the scissors, and cauterizing the wound 
with perchloride of iron or nitrate of silver. 

Another method is to pull out the feathers from the inner side 
of the wing, as far as the elbow joint, the skin being then incised 
with a bistoury somewhat below the joint, and dissected and 
reversed upward, the bones being then divided with the bone 
forceps. The wound should be carefully washed or sponged with 
cold water, to check the bleeding, and the skin drawn over the 
stump, secured by interrupted sutures. The bird requires no 
special attention, and the wound heals in a few days. 

Amputation of Hokns. 

The amputation of horns is an operation the description of 
which dates back to 1790. It is indicated in cases of fractm-es, or of 
vicious growths which might embarrass the motions and prevent 
the usefuhiess of the animal, and also to j^rovide against the mu- 
tual injuries which cattle are hable to inflict upon one another. 
It is also indicated in cases of suppurative collections in the si- 
nuses, and for the removal of parasites from those cavities. It has 



AMPUTATIONS. 275 

of late not only assumed a j)lace among the operations of fashion, 
but has found favor from its alleged tendency to improve the 
quantity and quality of milk, and of the flesh yielded by animals 
subjected to it. It is in relation to this hypothesis that Gourdon 
considers it as "a great progress in the raising of horned cattle, 
and which, on account of the benefits that may be derived from 
it, is perfectly justifiable." The operation is comparatively a sim- 
ple one, but nevertheless involves special considerations, varying 
according to the species of the animal. 

1st. In Bovines. — If only the free extremity of the organ is 
to be cut off, it is done with the saw carried rapidly through the 
horny structure, the animal, of course, being properly secured. 
But occasionally, especially in cases of fracture, the section is to 
be made near the base, or the middle of the horn, and soft and 
sensitive tissues are also involved. The amputation must then be 
made below the fracture with a sharp saw, apphed perpendicularly 
to the long axis of the horn, and completed as rapidly as possible. 

The operation will be accompanied by some hemorrhage, but 
not svifficient, usually, to require the apphcation of severe hemo- 
statics. The wound is dressed with pads of absorbent cotton, 
or of carboHzed or antiseptic oakum, retained by compresses or 
the Maltese cross bandage. Possible collections of pus must be 
watched for, and the sinuses shovdd be carefully cleaned by injec- 
tions. 

The dressings are renewed as often as the indications require, 
and continued until the granulations have closed the ca\ities of 
the sinuses, and the suppuration has almost entirely subsided. 
The application of a permanent dressing in the form of a pitch 
plaster is recommended by Gourdon. It need not be i-emoved, 
like the ordinary dressing, and under some circumstances is of 
great advantage. 

Among the probable accidents attendant upon this operation, 
there are four which require mention : 

(a) Hemorrhages, more or less serious, always occur after 
the section of the horn, and of its bony support. Usually, it is 
sufficiently arrested by the dressing alone, but there are times 
when the application of the actual cautery becomes necessary to 
subdue it. 

(b) Inflammation of the mtieous membrane of the sinuses may 
also foUow. In its ordinary manifestation it is not serious, and is 



276 OPERATIONS ON BONES. 

likely to terminate either by resolution or even suppuration, though 
in a few cases it may be followed by gangrene. 

(c) Gangrene, which generally manifests itself toward the 
eighth or tenth day, ordinarily ends in death, and is often accom- 
panied by an attack of ophthalmia more or less violent. 

(d) Incomplete cicatrization of the stump, occurring principally 
in cases in which the wound has been neglected, and suffered to 
remain too long unprotected by a dressing, and when the mucous 
membrane of the horn has become the seat of chronic inflamma- 
tion. A central fistula usually results, accompanied by an abun- 
dant suppuration, which is apt to prove exceedingly intractable to 
treatment. 

2d. In many young rmninants this operation is performed on 
calves two or three months old, and consists in removing the rudi- 
mentary horns. For this Charlier has invented a peculiar tre- 
phine kind of circular gouge, which is used as follows : The ani- 




FiG. 290.— Charlier'B Method of Amputation of Horns in a Calf. Ist Step. 

mal being thrown and held by two assistants, the hair is cut short 
around the base of the horns, and the trephine appHed over the 
horns in such a manner as to divide the skin and subjacent tissues 
down to the frontal bone where they are isolated by a circular in- 
cision. Then by a downward and horizontal twist of the trephine 
the divided structures are gouged out and the secreting matrix of 



AMPUTATIONS. 277 




Fig. 291.— Charlier'8 Method of Amputation of Horns in a Calf. 2d Step. 

the horn removed. The hemorrhage is controlled with a com- 
pressive bandage or other hemostatic, and antisejDtic dressing- 
applied. The wound generally heals rapidly and without compli- 
cations. 

Amputation of the Tail. 

For some unexplainable reason the term " docking " has been 
appUed to this operation, which is simply the removal of some of 
the vertebrae composing the caudal appendix. It is one of the 
most peculiar among the operations of fashion, although, of 
course, under some sj^ecial conditions incident to all animals, it is 
also sometimes perfoi-med as an operation of genuine beneficent 
sui'gery. This may be the case, for example, when the tail is abnor- 
mally so long and heavy as to interfere with the usefulness and 
comfort of the animal, or when it becomes the seat of disease and 
becomes affected with caries or necrosis, or fistulous tracts, or af- 
fections of the skin. In some instances, also, this curtailing oper- 
ation does constitute a true siu'gico-therapeutical means of obtain- 
ing a local bleeding. 

Docking, which is of Enghsh origin, is now performed all over 
the world, and has given rise to a great deal of controversy upon 
the question of its propriety. Whether it is an act of inexcusable 
cruelty or not, it is not at present our province to decide, but from a 
surgical point of view we feel that it is due to truth to say that we 
are satisfied that a great deal of what has been said in opposition 
to the operation results, from the various and, too often, bungling 



278 



OPERATIONS ON BONES. 



and cruel methods which have characterized the details of the 
amputation. We believe that some of these methods may be so 
modij&ed as to reheve the operation of its apparent character of 
cruelty. We refer now especially to the means which have been 
and are employed for the arrest of the hemorrhage which is likely 
to follow the section of the blood vessels of the region. 

The tail has for its bony support a series of the caudal verte- 
brae — from fifteen to eighteen — varying in number and diminish- 
ing in size from the sacrum to the end of the organ, and united 
by a thick inter-vertebral ligament, and attached to them are the 
caudal muscles in pairs, three on each side, the stqMriors or ele- 
vators, the inferiors or dep7-essors, and the laterals or inclinators. 
Beside these, there is also the ischio-caudal muscle, which extends 
from the ischiatic ligament upward and backward to terminate on 
the sides of the first caudal vertebrae. Between each of the lateral 
and inferior caudal muscles runs the lateral caudal, and on the 
median line between the inferior muscles the median caudal ar- 
tery, all running to the end of the tail, and hkely, when divided, 
to cause a more or less troublesome hemorrhage. All these or- 
gans are sui-rounded by the caudal aponeurosis, from the deep 
surface of which proceed bands which form a sj)ecial sheath for 
each muscle, and is ultimately united by its external face to the 
thick skin which surrounds the region. This skin on the upper 
and on each lateral face of the tail is covered with long, thick, 
coarse hair, while the inferior face is hairless, smooth and com- 
paratively thin. 





Fig. 292.— Tail Cutters. 



AMPUTATIONS. 



279 



Dockiiig properly includes three steps : 1st, the preparation 
of the tail ; 2d, the amputation ; and 3d, the arrest of the hemor- 
rhage. (There is, however, a mode of operation in which the last 
two steps can be merged into one.) The animal is kept in the 
upright position, and well secured. 

1st Step. Preparation of the Tail. — This is first well washed 
and combed, and ought to be cleaned with an antiseptic solution. 
The place where the amputation is to be performed should be 
marked by clipping the hail' from it in a circle, and above this the 
hair should be secured either by being braided, or simply tied 
tightly in a mass with a string aroiind the tail. Some practition- 
ers apply a cord hgatiore or an elastic bandage above the place to 
prevent the hemorrhage. 

2d Step. The Amj^utation. — This is accompUshed by several 
methods. The oldest mode was by using a simple hatchet as the 
instrument with which the tail, properly prepared and laid over a 
wooden block, was severed by a heavy blow on the "instrument." 
(Fig. 292). 





Fig. 293. 



Tail Cutters. 



Fig. 294. 



280 



OPERATIONS ON BONES. 



At a later period, special knives called tail cutters, were in- 
troduced. These were peculiar large shears, differiag more or less 
in general form and in that of their cutting edges, but which were 
used in the same manner, and are stUl in common use by many- 
practitioners. The manner of using them is very simple. The tail, 
prepared as before mentioned, and held horizontally by an assist- 
ant, is so placed in a hollow formed in the edge of the shears as to 
insure a perpendicular stroke, and the division is made by closing 
the blades with a single quick and forcible motion. Other instru- 
ments were invented to work by springs. 




Fig. 296.— Spring Tail Cutter. 



Some practitioners, instead of dividing the entire thickness of 
the organ, prefer to do so by disarticulating the vertebrse with a 
bistoury, first making flaps on each side of the skin in order to 
find the joint. 

3d Step. — To stop the Hemorrhage. — The moment the tail is 
amputated three streams of blood spring from the stump, with 
more or less force, according to the position of the member, unless 
a ligature or an elastic bandage has been previously appHed. In 




AMPUTATIONS. 281 

either case attempts may be made to ligate or to employ torsion 
of the arteries, but the hemostatic generally emj)loyed is the actual 
cautery. The tail-cauterj^, heated to nearly a white heat, is firmly 
held upon the truncated tail for a few seconds until it has stopped 

the hemorrhage. To assist this 
process and obtain the formation 
of a thicker scab, certain com- 
bustible substances are some- 
times placed upon the wound 
before the cautery is apphed, to 

Fig. 297.— Tail Cautery, . i.i_ i„ i. i j.i, • • • 

mcrease the heat by their igni- 
tion. A ring of hair or a little pulverized resin may be employed 
for this purpose. 

We have before noted that in this measure of hemostasia there 
is much that is repulsive and coarse, and that it is not at all in har- 
mony with the spirit of modern scientific surgery, and we have 
long felt a conviction that a great improvement is possible in the 
manipulation of such a case. "VVe have, therefore, made the matter 
one of careful experimentation, and the conclusion we have reached 
is that the following course of procedure will meet all the indica- 
tions and fulfil all the purposes contemplated, and at the same time 
avoid the compUcations likely to occur, and obviate the objections 
of the sensitive and the timid, besides securing results entirely 
satisfactory to all the parties concerned. 

First, to render the operation painless, we inject cocaine at two 
or three points in the circumference of the tail skin. Then, around 
the tail, and above the ring made by clipping the hair, as before 
mentioned, to mark the place of amputation, we place a narrow 
elastic band at a tension merely svifiicient to stoj) the hemorrhage. 
Having waited for the full efi"ect of the anesthetic, and accurately 
identified the center of the articulation between two of the vertebrae 
through which we intend to amputate, with a strong and sharp 
bistoury we make rapidly a circular incision of the skin entu'ely 
around the tail, and, if possible, divide the muscle with a single 
stroke through the intervertebral Kgament. With a little care and 
practice the amputation may be completed in a few seconds, and 
there remains at the end of the tail but a smooth, perfectly blood- 
less stump. We cover the fresh surface with a dressing powder, 
antiseptic, caustic or astringent as indicated, and leave the patient 
eating his oats as he had been doing during the operation, unaware 



282 OPEEATIONS ON BONES. 

of the mutilation to which he has been subjected. We leave the 
elastic band in place for from twenty-four to thirty-six hours, pos- 
sibly loosening it once during that time, or tightening it, if any 
oozing of blood is discovered, and removing it entirely as soon as 
it becomes safe to do so. 

The stump generally needs no special care, except in cases of 
possible complications which may follow the operation. The am- 
putation of the tail by flaps is also jaerf ormed by some veterinarians 
with great siiccess, this mode leaving a wound which generally heals 
very rapidly and without the ordinary possibility of complication. 

Among these are, first, hemorrhage. The occurrence of this 
is an evidence that the hemostasia has been imperfect, proba- 
bly the cauterization has not been sufficiently thorough; or the 
torsion of the arteries has been insufficient; or the hgature has 
been loosely tied. This accident requires a repetition of the man- 
ipulation, and perhaps another cauterization or torsion or ligature. 
With the apphcation of our elastic band this can scarcely ever oc- 
cur. If it does, another turn of the band will complete the work. 

Bad aspect of the Stump. — The amputation of the tail by sec- 
tion through the continuity of the bone, as commonly happens 
when the tail-cutters have been used, leaves in the center of the 
wound a projecting portion of a vertebrae, which is usually burnt 
by the cautery, when this has been used. As the result of this, 
and surrounding the mortified bone, large granulations rapidly 
appear, overlapping the circular edges of the wound, and char- 
acterized by an abundant discharge. The necrotic bone must 
then be amputated and the granulations heavily cauterized with 
caustics of the potential kind ; the saturated solution of chloride 
of zinc making an excellent prescription for the purpose required. 
To obviate this complication the operator will do well, when any 
portions of vertebrae have been left in the stump, to remove the 
fragments with the bone forceps rather than to wait for their re- 
moval by the natural process of necrosis. We have never encoun- 
tered these comphcations when using the elastic band, being 
careful to amputate at the articulation of the vertabrae. The 
powdered dressings we have used have always kept the granulations 
under control. 

Multiple Abscesses. — We have met these once, as the result 
of the presence of a very thick scab, which prevented the escape 
of the underlying suppuration. 



TREPHINING. 283 

Gangrene and Tetanus have also been recorded as sequelae of 
this operation. 

The rules we have given apply without change to the amputa- 
tion of the tail in smaller animals, as sheep, dogs and cats. 

TREPHINING. 

The operation of trephining or trepanning consists in boring 
into or through a bony or other hard structure, in order to form 
an aperture for surgical purposes. Although the cranium is 
usually the seat of the opening, it may be made in any part of 
the body where the indications demand it. 

The apphcation of the trephine or of terebration, as it is called 
when it is performed at the base of the horns of cattle, dates back 
to antiquity, having a record antedating the time of Hippocrates, 
and yet it was not until toward the year 1749 that it in fact entered 
the domain of veterinary siu'gery. About that time Lafosse, Sr., 
performed it to open the frontal and maxillary sinuses in the 
treatment of glanders and other diseases mistaken for it. It was 
afterwards recommended by Greave and Haubner as the proper 
treatment for the rehef of purulent collections in the sinuses of 
the head, and it has been recommended by many others for 
parasitic affections of the cranial cavity, as cases of coenurus 
cerebralis. 

Trephining is undoubtedly indicated in many pathological 
conditions, and in fact ought to be more frequently practiced 
by the veterinarian of to-day. Much has been lost, no doubt, by 
its neglect and disuse. Its value is most fully demonstrated in 
cases where it becomes necessary to remedy the effects of mechan- 
ical lesions taking the form of bloody or purulent gatherings 
within the cranium, like those which may result from the pressure 
of fragments of fractured bones upon the brain. Fractures of the 
cranial bones resulting in this manner are not common with our 
domestic animals, but when they do occur they are always of a 
serious nature, and too often are beyond remedy. In a case of 
remediable character the removal of the pressure ujDon the men- 
inges by trephining and cleansing the wound from the matters 
which produce and continue it, whether bony fragments or bloody 
extravasations, is the treatment indicated before any other. Yet 
as experience has many times proved that the brain is able to sus- 
tain a very considerable amount of pressure without betraying 



284 OPEEATIONS ON BONES. 

any signs of inconvenience, the indication of trephining only 
becomes absolute when serious nervous manifestations are ex- 
hibited. In simple contusions, or even with complete fracture of 
the bone, trephining is not indicated unless brain lesions are 
unmistakably present. 

It is indicated in solipeds in cases of chronic discharges pro- 
ceeding from suppTirative collection in the sinuses, characterized 
by a yellowish, grumous, and often offensive, running at the nose, 
usually from but one side, and not uncommonly accompanied by 
a deformity of the face, caused by a bulging of the bones, and 
associated with it a dullness on percussion over their surface. 

Jessen & Unterburger have also recommended it in cases of 
suppuration in the cavities of the nasal turbinated bones. In the 
treatment of chronic catarrhal inflammation of the horns or of the 
portions of the frontal sinuses which extend into the apjDendix of 
the head, in ruminants, it has given excellent results. 

It is also indicated for the removal of foreign bodies, either of 
a pathological nature or the product of wounds, entering the 
cranium from the outside. It is available for the removal of 
polypi or any kind of neoplasm, of migrating dental cysts, of 
odontomse, or as one of the first steps in the operation for the 
removal of diseased teeth from their alveolar cavity; in all these 
cases it is the first indication. It is also of common application in 
extracting parasites, the coenurus especially, from the cranial cav- 
ity of small ruminants, when their location has been first positively 
ascertained. In some severe cases of diseased withers accom- 
panied with abundant suppuration, which may filtrate under the 
internal surface of the scapulae, and accumulate between that bone 
and the thorax, it has been claimed that, performed upon the 
scapula, it would furnish an eligible means of reaching the bottom 
of the collection, and providing suitable drainage and consequent 
relief. 

Trephining the wall of the foot in special cases of laminitis, 
to assist the escape of the effused blood from between the 
laminoe has also been tried, but with what results we are not 
informed. It has even been performed in the treatment of immo- 
bility, but so far as we have learned, has never been followed by 
satisfactory results. It is also referred to in connection with the 
cranial inoculation of rabies, as performed by Pasteur. 

The special instrument employed in the operation is the 



TREPHINING. 



285 



trephine, or trepan, in various modified forms. There are also 
others which may be considered as accessory, viz., scissors, bis- 
touries, forcej)S, bone-scrapers and elevators. 

The brace and bit trephine is the original instrument which 
has been more or less modified, and which, while it is capable of 
more rapid execution, is probably less controllable than the ordin- 





FiG. 299.— Bichafs Trephine. 




Fig. 298.— Old-Fashioned Trephine. 



Fig. 300.— Single-Handed Trephine. 



286 



OPERATIONS ON BONES. 




Fig. 301.— Operation of Trephining. Modus Operandi. 



ary trephine (Fig. 300), and therefore not so safe. The single- 
handed trephine is also to be preferred from the fact that the 
former requires both hands to manage it, while the latter can be 
manipulated with a single hand. They are both what might be 
properly denominated true circular saws, if judged by the result 
of their appHcation, which is the removal of a circular portion of 
the bony structure, and a corresponding round opening, through 
which other surgical indications can be fulfilled. 

A simple gimlet has often taken the place of the regular instru- 
ment, but such an appUance can be considered as possessing little 
more than the character of a mere exploring needle, from the 
impossibility of making an opening with it of sufficient dimen- 
sions to be available for any other practical use. 



TREPHINING. 



287 



The hone-scrapers^ or elevators, which are sometimes employed 
as accessory, are used for preserving the periosteal covering of 
the bones; for removing the rough edges of the opening; or in 




Fig. 302.— Bone Scrapers and Elevators. 

raising the bony fragments which have been crushed in, or may 
be pressing against the cerebral substances. 

An important step before entering ujDon the operation, is to 
determine the points which are to be avoided. Generally speak- 
ing, any part of the head or of the body can be operated upon, so 
long as there is a bony surface that can be readily exposed without 
danger of injimng other important organs. But, upon the head, 
the angles of bones and the tracts of the cranial sutures ought to 
be avoided. In the more common apphcations of the operation 
upon the head (Figs. 303, 304), one of four principal points is gen- 
erally selected, b}' which to effect an entrance into the cavities of 
the sinuses. The points marked h, near the lower borders of the 
frontal bone, will open the frontal sinuses : the point c, upon the 
surface of the nasal bones, communicate with the superior part of 
the nasal ca\-ities in the upper portion of the turbinated bone; the 
points e, upon the zygomatic bone, will enter the superior, and f, 
upon the great maxillary bone, will penetrate the lower maxillary 
sinus. Besides these specific regions upon which to apply the 



288 



OPEBATIONS ON BONES. 





Fig. 303. Fig. 304. 

Parts of the Head where Trephining is Performed. 

instrument, there are conditions where, the bone being less sub- 
cutaneous, the operation is less easily performed. Such is the 
case as to the lateral faces of the parietal bone, where it will be 
necessary to penetrate through where the crotaphite muscle is. 
This, however, makes a compHcation of little importance. Again, 
there are indications, such as in cases of chronic coryza, with sup- 
puration of the sinuses, where a double trephining becomes neces- 
sary, one to enter the frontal, and the other the superior maxillary 
sinus. Figure 305, which is borrowed from Peuch & Toussaint, 
shows the exact location where the trephining can be made. 
A, entering into the frontal; B, the upper, and C, the lower max- 
illary sinuses. 

The modus operandi of this operation is very simple. Unless 
the animal is very restless, and cannot be controlled by the ordi- 
nary means of restraint, or by local anesthesia, and must there- 
fore be cast, or unless the trephining is merely the first step of an 
operation to remove foreign bodies or growths from the sinuses, or 
to apply special action upon a displaced bone, as in a fracture, we 
prefer to operate in the standing posture, and in such cases have 
found the use of cocaine of great advantage. 

In any case the skin is first divided by either a V, or a T, or a 



I 



TKEPHINING. 



289 




Fig. 305.— Common Points of Selection for Trephining. 

semi-lunar incision. We prefer tlie first as being least liable to be 
followed by a blemish. The periosteum is divided in the same 
form, if its division has not already followed that of the skin. 
The flap thus formed in two structures is then carefully raised 
from the attachment to the external surface of the bone, and 
held aside by an assistant, vnth. either a blunt tenaculum or 
forceps. The instrument is then implanted ujpon the centre of 
the exposed bony surface, and by the rotatory or semi-rotatory 
motion imparted to it, gradually separates a circular disk of the 
bone. The pressure necessary to make the instrument seize or 
bite on the bone may at first be considerable, but as the trephine 
penetrates, the force must be carefully relaxed in order to avoid 
the hazard of injuring the parts beneath by the sudden yielding 
of the bone and plunging of the instrument into the parts beneath, 
accompanied by the bony disk, as it separates from its last attach- 
ments, perhaps passing beyond reach, and costing no little touble 
and danger before it can be discovered and removed. 

It is not judicious to penetrate through the bone at once. As 
the operator feels that he has nearly reached the last turn, the 



290 OPERATIONS ON BONES. 

safe plan will be to partly separate the disk with a partial, oblique 
turn of the trephine, and to complete the separation with the 
elevator. Sometimes this segment will be retained in the crown 
of the instrument, or, again, it will be only partially loosened. In 
that case, securing it with a pair of bull-dog forceps, its excision 
can be made complete with the bistoury, by dividing the mucous 
membrane of the sinus which may hold it. If the edges of the 
opening in the bone are not perfectly smooth, their asperities 
should be removed with the bone scrapers or bone knives. 

The indications following the perforation of the bone vary 
according to the case. If it is a fracture, with pushing in of the 
bone, the fragments, or the bone debris, must be removed by 
being raised with the bone elevator, cutting from within outward. 
If a removal of a parasite of the cranial cavity is to be effected, its 
membranous envelopes may be carefully twisted around the jaws 
of the forceps, and thus removed in a single mass. In cleansing 
out a purulent collection in the sinus, it must be injected and 
washed with the proper medicated solution. If, on the contrary, 
the removal of a foreign body is necessary, as a polypus, or an 
odontoma, or the extraction of a molar tooth by gouging, it may 
become necessary to enlarge the opening. This is done either by 
chipping off the edges with the bone forceps, or by making another 
opening with the trephine, adjoining the first, and merging them 
together by properly trimming and shaping them. 

The dressings required after trephining vary according to cir- 
cumstances. If the trephining has been but a preliminary step 
to a subsequent manipulation, such as the raising of a fragment 
of fractured bone, or for the removal of foreign bodies, the woimd, 
after being thoroughly and antisepticaUy washed, can be closed 
by bringing the edges of the integument together by sutures, and 
covering the surface with a pad of oakum, kept in place by a fig- 
ure 8 roller, around the head, or by one of the frontal, single or 
double, already described. If, however, the operation has been 
performed in a locahty where there would be difficulty in retain- 
ing such a dressing, the application of agglutinating preparations 
or plasters wiU effect the object. 

When the frontal and maxillary sinuses have been opened, and 
it becomes necessary to wash out their cavities by injections thrown 
into them, the trephined opening must be prevented from closing 
by the introduction of a tent of oakum and a kind of soft cork, 



PEKIOSTOTOMY. 291. 

which may be kept in place by securing it to the halter of the 
patient, to prevent it from falling into the sinus. 

The cicatrization of the wound made by the trephining in- 
strument springs from the rapid development of granualations 
which soon fill up the opening. These granulations soon undergo 
the various changes which take place in the process of calcification 
and ossification, and the loss of bony substance is soon completely 
repaired. 

In a few instances, however, the seat of the operation, after a 
few days, assmnes a most unfavorable aspect, becoming swollen 
and offensive, and betraying the characteristic necrotic odor. In 
many instances the seat of the necrosis is found to be the edge of 
the opening, and is due to the imperfect apphcation of the tre- 
phine, and the destruction of the periosteum. Care must then be 
taken to remove all the loose necrotic fragments. To allow them 
to remain imbedded in the granulations and under the skin, will 
be to incur the certain hazard of the development of abscesses 
and the formation of fistulous tracts, which wiU refuse to heal 
until the last particle of diseased bone has been exfoliated and 
removed. 

PEKIOSTOTOIHY. 

Periostotomy is an operation which consists in the subcutaneous 
division of the periosteum, on the surface of bony growths. It 
may be for the purpose of stimulating their resolution, or it may 
be to relieve the pain arising from the tension of the inelastic 
membrane as it is pressed upon by a tumor of the bone growing 
under it. The operation was originally performed by Professor 
Sewell of the Koyal Veterinary College in 1846, and was at first 
considered to be one of the neatest and most scientific among the 
methods practiced for the rehef of the lameness due to exostoses. 
It was considered by SeweU himself to be far superior to any 
other means then in use, counter irritations, firing, and the rest. 
But although earnestly supported by the authority of its inventor, 
periostotomy has not sustained its claims by exhibiting all the 
results which were promised for it, and experience has shown that 
it is in many instances not only a useless, but even a dangerous 
operation. Several special instruments are necessary iu its per- 
formance. These are a peculiar roioel scissors (Fig. 306) to incise 
the skin, for which, however, a special bistoury (Fig. 307) is 



292 



OPERATIONS ON BONES. 





Fig. 306.— Scissors. 307.— Bistoury, 308.— Periostome. 309.— Seton Needles. 

sometimes substituted ; a periostome (Fig. 308), a kind of blunt 
bistoury, narrow and curved; and two flat needles (Fig. 309), 
short and curved flatwise, one of which is blunt, and used to di- 
vide the connective tissue, the other being sharp and to be used 
as a seton needle to pass a tape into the subcutaneous incision, if 
it is judged necessary. These needles may either be inserted into 
a handle, or used free. 

The operation is a simple one to perform. The animal being 
cast and properly secured, an incision is made with the rowell 
scissors or the bistoury, at the most dependent parts of the bony 
growth, large enough to aUow the introduction of the blunt curved 
needle. This being pushed slowly under the skin, separates it 
from its attachments, and upon being gradually withdrawn, the 
periostome is passed into the tract thus formed, directly over 
the bony tumor. Turning the sharp edge of the periostome on 
the exostosis, and pressing it over the periosteum, this is divided 
by subcutaneous strokes down to the most superficial layer of the 
exostosis, which may be incised by the instrument. 

When the tumor is of long standing, a seton may be intro- 
duced by pushing into the tract, from which the periostome has 
been removed, the curved needle which carries the tape, and it is 
brought out by an opening made at the highest part of the tumor. 

Sewell claims that after twenty-four hours the parts become 
the seat of a large swelling, and more or less inflammation may take 
place, but after twelve days the animal is ready to resume his 
work, the swelling having gradually subsided, and the lameness 



RESECTION OF BONES. 



293 



passing oflf, sometimes the enlargement haying disappeared. Our 
own observation, however, differs from that of Sewell and agrees 
with that of Keynal, as we have seen cases where excessive inflam- 
mation has followed the operation, accompanied by the persistent 
development of large indurated swellings, intractable to any other 
form of treatment, and giving rise to permanent lameness. This 
operation, although highly recommended by English practitioners, 
especially in the treatment of splints, is not, however, held in the 
same estimation by Continental veterinarians. 

RESECTION OF BONES. 

The resection of a bone is the removal of a portion of its sub- 
stance, for the connection of a deviation from its normal position, 
or other deformity, or in cases of fracture, or necrosis, or other 
incurable disease. It is to a bone what excision is to the soft 
tissues. It has been known for a long time, but it is within only 
a comparatively recent period that it has found admission into 
veterinary surgery, and even now it is but seldon practiced. It 
is practicable on all parts of the skeleton, but there are some 
special conditions in which it is more evidently indicated than in 
others, such as cases of necrosis in the vertebrae, gi-^dng rise to 
obstinate fistulous withers, and in the treatment of some exostoses ; 
or again in that of the complicated wounds accompanying frac- 
tures. 




'--Hi 



Fig. 310.— Various Forms of Saws. 



294 



OPERATIONS ON BONES. 




Fig. 311.— Chain Saw. 




Fig. 313.— Bone Forceps. 



I 




Fig. 313.— Gouge. 



Fig. 313a.— Chisel. 



Fig. 313&.— Mallet. 



The instruments necessarj"^ are quite numerous. Saws of 
different forms, including the chain saw, the bone forceps, or 
shears, the gouge, the chisels, and the mallets are all brought 
into requisition at times. Before making a resection the diseased 
bone must be thoroughly exposed by a free and long incision, 
giving ample room to the surgeon for the free use of the instru- 
ments. If the bone is already exposed, great care should be taken 
to protect the soft tissues, the muscles, the blood vessels and the 
nerves, from being accidentally wounded, by covering them with 
compresses, cloths, or other substances. 



RESECTION OF BOXES. 295 

The manipulations will of course vary, according to the bone 
which is to be incised. When one of the long bones is to be re- 
sected in its long axis, either in part or in whole, the periosteum 
must be kept as nearly intact as possible ; as the principle regen- 
erator of the osseous tissue, its removal would necessarily interfere 
with the cicatiizing process. It must be very carefully separated 
from the bone, and isolated, to the whole extent of the segment 
to be removed. This done, the bone can be readUy cut off, with 
either the chain saw or the plain instrument. The resection of 
bones in their articular extremities seldom occurs in ovu: practice ; 
it sometimes becomes necessary in diseases of the vertebrae, in fis- 
tulous -nithers, and occasionally in caries of the ribs. 

In the first case, that of the diseased vertebrse, the excision is 
commonly made with the bone forceps and chisels, or even with 
the gouge. The principal point to observe in these instances is 
to avoid injury of the ligamentum nuchoe as much as possible, 
and to save aU the periosteum that can be preserved. 

The resection of ribs is accomplished with difficulty, on account 
of the proximity of the pleura which lines their internal surface. 
To avoid woimding this important organ the rib is exposed by a 
longitudinal or crucial incision, and after isolating the intercostal 
muscles from their attachments, the pleura can be pushed away 
from the bone with the blunt end of a scalpel, and with the chain 
saw introduced carefully between the bone and the pleui'a, the 
resection can be accompHshed by dividing the bone from Avithin 
outwards. The hemorrhage which arises from the intercostal 
arteiy can be stopped by plugging. The wound is dressed by a 
protective antiseptic bandage applied round the chest. 

The general indications, after the resection of bones, are to care- 
fully watch the progress of the wound and watch for the possibility 
of the formation of fistulous tracts, which may result from the 
extension of the necrosis, which may not have been entu'ely re- 
moved, or may result from the removal of the periosteum. These, 
however, may often be prevented by so regulating the process of 
granulation, as to prevent the accumulation of pus in the wounds, 
and if necessary, by applying caustics or resorting to any other 
of the means recommended to fulfil the existinof indications. 



CHAPTER VII. 

OPERATIONS ON MUSCLES AND THEIR 
ANNEXES. 

CAUDAL MYOTOMY. 

This operation, more commonly known under the name of 
pricking, is exclusively performed on equines, and is designed to 
diminish the power of contraction of certain of the muscles of the 
tail. However it originated, it has been perpetuated by a class of 
horse fanciers who have, to a certain extent, made it a dictum of 
fashion, and by whom it has been supposed to improve the 
symmetry of the animals upon which it is inflicted But it has 
lost, in our day, much of the estimation in which it was once 
held, and while at first, before its prestige had been weakened, all 
kinds of horses, indifferently, became victims to the bad taste 
and thoughtless cruelty of the custom, either the external form of 
our horses and the mode of attachment of their tails have been 
improved by more skillful methods of breeding, or they have in- 
stinctively learned the regulation style of carrying their caudal 
extremities. Whatever may be the cause, the fact is beyond 
dispute that the indications for the operation have considerably 
diminished. 

But though the effect of the division of the inferior caudal 
muscles is in fact, with some animals, to cause them to carry 
their tails in lines more graceful and more horizontal than before, 
it is stni necessary, in order to accomplish a successful result, 
that the tail should be properly attached to the body as a con- 
genital arrangement, or well set up on the sacrum. A horse 
with an oblique sacrum, with the tail set low and close to the 
ischial tuberosities, can never be a good subject for the operation, 
or made to serve as a favorable example of the beautifying effect 
of pricking. 

But with aU this, there is sometimes a condition which (look- 
ing not to the welfare of the horse, but solely to the conveniences 



CAUDAL MYOTOMY. 297 

of his master), renders caudal myotomy an operation of necessity. 
This occurs with those animals which have contracted the annoy- 
ing habit, when driven in harness, of switching their tails over the 
reins and, in effect, grasping and holding them so tightly that it 
is only with difficulty that they can be extricated — often placing 
the driver in a position of imminent peril by making it impossible 
to control their movements at a moment when perhaps a disas- 
trous collision or other dangerous encounter may impend. 

There is also another condition which relieves caudal myotomy 
from the imputation of relying for its justification exclusively on 
the plea of being in the fashion, though it involves only the 
sordid argument of a money consideration. This condition is 
found in the case of the animal which carries its tail sidewise or 
with a lateral curvatiu'e — a deformity which may in many instances 
considerably diminish his market value. In other words, if the 
contra-indication of the operation is the fact of bad conformation 
of the animal and a low insertion of the tail, the indications, leav- 
ing aside the question of good appearance, no matter if the tail is 
attached low or high, are when the horse has the habit of taking 
hold of the reins by switching it over them, and again when the 
tail is carried crookedly sideways. We proceed to consider the 
operation under all the requirements. 

Caudal Myotomy Proper, or Pricking, means the division of 
the two inferior sacro-caudal muscles, for the purpose of dimin- 
ishing their contractile power. It is performed in several ways, 
most of which consist not only in the division of the muscles, 
but in the removal of a portion of the muscular substance. 
There is, however, one method of which we have failed to dis- 
cover any mention by European authors, and which' we have for 
years practiced in the United States, where it has been in vogue 
for a period of more than forty years. This mode of operation 
we shall consider in another place as the " American method.'''' 
A glance at plate 314 will show the peculiar anatomical position 
of the muscles, blood vessels, and nerves of the region to be oper- 
ated upon. Peuch and Toussaint refer to six modes of operations, 
but we think the matter can be judiciously simplified by reducing 
the number by at least one-half. We shall therefore adopt a sim- 
pler classification, and describe the operation as it is performed 
by, first, the transversal incision ; second, the longitudinal ; and 
third, the transversal and longitudinal in combination. 



298 



OPEBAXXOKS O. MUSCBS ... ,hkzk .'..™. 




!?;. ^--SuBpeneory 1Wamlnr.n;^° coccygeal m^uS! T/!^?f: 



^—Portion of th« o^ "^^ ^'^"tiai -Kegions. 

-One of the snn«lfi?:,-„,^i:rJ^.'»Pbatic glands, ii. io^_'^c^?i55i^'lal 



arteries 
artery. 



3010 — Inferior oaiidni ,. ""® ^* *^e median aru,^ A'~if'^^^^^ caudal 
8 muscle. 17 1?" Sf.^'^ranosus muscle, i.^ -i-s.^,?:-?^^*'^'!. of the perinea 



CAUDAL MYOTOMY. 



299 



The patient must be kept, as much as possible, iu the standing 
position, with a twitch on his nose, and his hind legs hobbled, or 
seciu'ed with the hippo-lasso ; or if he is of a very excitable and 
restless disposition, the stocks should be brought into requisition. 
The decubital position is, in our opinion, unnecessary, and un- 
doubtedly a very inconvenient one for the svu-geon, and not at all 
contributive to the performance of a neat operation. "We have 
often used cocaine when pricking horses, and it has in many in- 
stances j)roduced all the excellent effects of general anesthesia; 
and we prefer it, therefore, to the inhalations of chloroform which 
some recommend. 

1st. Operation by Transverse Incisions. — The instruments 
required in this mode are a bistouri a serpette, an instrument re- 
sembling that known as bistouri cache of owe obstetric cases; 




FxG. 315.— Bistoury for Caudal Myotomy. 

a sharp convex bistoury, and a bull-dog forceps, or a pointed 
tenaculum. The animal being secured in position, an assistant, 
placed on one side of the croup of the patient and facing 
the operator, raises the taU perpendicularly and well on the 
middle of the back of the patient, in order to render the mus- 
cles tense and cause them to project well under the fine, soft 
skin which covers that region. The operator, dii-ectly facing 
the posterior parts of the animal, then firmly grasps the tail with 
his left hand and steadies it, while holding the blade of the 
bistouri a serpette between the right thumb and index finger, close 
to its sharp part, and plunges the instrument through the skia 
and the entire thickness of the muscle, beginning on its inside 
border, or slightly on one side of the median line, and carrying 




Fig. 315a.— How to Hold the Bistoury and Make the Incision. 



300 



OPERATIONS ON MUSCLES AND THEIR ANNEXES. 



These 
operation. 



the incision outward, right across the entire width of the muscle. 
The incision must run through the entire thickness of the organ 
and ought to be made by a single stroke of the instrument. The 
first incision is to be made about three fingers width from the base 
of the tail ; the second from one inch and a half to two inches 
back of it, and the third, if not considered unnecessary, at the 
same distance from the second. Owing to the tapering form of 
the tan, the incisions should become shorter as they approach the 
end of that member. When all the incisions are made on the 
right side, the ojjerator, if ambidexter, changes hands and re- 
verses his mode of manipulation, j^roceeding otherwise in the 
same manner as before, being careful that all the incisions are 
made directly in line with one another, entirely across the 
muscle. 

first three incisions constitute the first step of the 
If the division of the muscle has been made through 
its entire thickness, the portions of tissue be- 
tween the incisions will slightly protrude, and 
these are to be seized with the bull-dog forceps, 
and drawn over to one side, while they are care- 
fully dissected away with the convex bistoury, 
placed flatwise, under the muscle, 
with the sharp edge turned up- 
ward, and separating entirely the 
two portions of muscles included 
between the incisions. The amount 
of muscular tissue thus removed 
will measure from three to four 
inches in length. 

The number of the incisions varies. At first 
one was considered sufficient, but the number was 
gradually increased to five, while at present com- 
mon agreement has fixed the rule at three. 

2. The Operation by Longitudinal Incisions. — 
This is comparatively an old mode of operating, 
which, having been once abandoned, was revived 
by Delafond, in 1833, when it was again reinstated 
in general practice. It requires for its perform, pig. giea.— Cau- 
ance only a stronsr, convex bistoury. The animal ^^^ Myotomy by 

•' °' , •' Longitudinal In- 

bemg secured in the usual position, and the tail cisions. 




Fig. 316. — Trans- 
versal Incisions in 
Caudal Myotomy. 




CAUDAL MYOTOMY. 



301 



kept as in the other methods, the operator makes on the middle 
of one of the projecting muscles a longitudinal incision, three or 
four inches long, di^^.ding at one stroke the skin and the fascia 
underneath. From the muscle thus exposed, a portion is dissect- 
ed, and by passing the bistoury under it, close to the vertebrae, it 
is removed by cutting it transversely at both extremities of the 
cutaneous incision. The removal of the muscle is made first on 
one, then on the other side of the median line. 

3d. Operations by Mixed Tncisiojis. — This was demised by 
Vatel, who made two transversal incisions on each side of the tail, 
from thi'ee to four inches apart, and uniting those of the same 
side by a longitudinal incision, made in the direction of each in- 
ferior caudal muscle, and then dissecting a portion of each organ 
with the aid of a bistoiuy, or a pair of scissors, securing a hold at 
one end with a pair of forcej)s, or a j^ointed tenaculum. 

The method patronized by Brog- 
niez, and recommended by Belgian 
veterinarians, requires two special in- 
stz'uments: the caudal dermatome, 
which is used for the division of the 
skin, and the caudal myotome for 
that of the muscles. The operation 
is minutely described by Director 
Degives, and includes the following 
steps: 

Two or thi'ee incisions are made 
on the prominent part of the muscle, 
parallel to its long axis, the first 
about two fingers' width from the 
base of the tail, a space of about half 
an inch being left between each in- 
cision. These incisions are made with the dermatome, pressed 
perpendicularly over the tissues to be di^sided. The two lower 
incisions are first made, then the two middle ones, and the two 
upper ones last. By this process the skin and subcutaneous fascia 
are divided. The myotome is then introduced under the muscle, 
from within outward, and after twisting it around the organ, di- 
vides it by turning the instrument so as to bring its sharp edge 
against the muscular tissue. Thus divided, the muscles protrude 
through the incision, and are then excised in the usual way. 




Fig. 317 — Operation by Mixed In- 
cisions (Vatel's method) 



302 



OPEEATIONS ON MUSCLES AND THEIR ANNEXES. 





Fig. 318.— Caudal Der- 
matome. 



Fig. 319.— Cau- 
dal Myotome. 



Fig. 330.— Brogniez's Mode of 
Operation. 



The American, or Subcutmieous Method. — This requires but a 
single instrument, viz.: a strong, straight tenotomy knife. The 
operator, having the animal in the usual position, with the tail 
under proper control, and holding his knife flat full in the hand, 
plunges it flatwise through the skin, with the sharp edge turned 
downward, from without inward, measuring carefully to intro- 
duce it at about the separation of the lateral and inferior caudal 
muscles, and pushing it as nearly as possible between the mass of 
the muscle and the vertebrae. When the instrument has pene- 
trated to near the median line, the sharp edge of the instrument 
is, by a twist of the hand, turned perpendicularly in the direction 
of the muscle, and by a careful sawing motion, the division of its 
fibers is accomplished. This is easily detected by a peculiar crack- 
ing sound, which ceases as soon as the entu^e thickness of the 
muscle is divided. The edge of the instrument can then readily be 
felt under the skin. The cutting must be carefully done in order 
to avoid the division of the entire thickness of the skin. A second 
and third division must follow, the number being equal on each 
side. 

There is also another subcutaneous mode, practiced by Ger- 



CAUDAL MYOTOMY. 303 

man veterinarians, but which is claimed by Hering to be uncertain 
as to its results. In this operation both a straight and a curved 
myotome are used. With the straight knife a small incision is 
made, parallel to the axis of the tail and close to the hair, and the 
curved myotome is then introduced between the skin and the 
muscle. A turn of the instrument brings its edge against the 
muscle, and by the usual sawing motion, the organ is divided from 
within outward, the blunt end of the myotome sliding upon the 
vertebrae. 

Neither of these subcutaneous methods include the removal 
of any portion of muscle. 

When the operation is finished, the animal may be relieved and 
the tail released without any apprehension of serious hemorrhage, 
although by reason of the unavoidable division of the lateral caudal 
arteries, a certain amount will necessarily take place. But this is 
not of a serious nature, and, as a rule, needs no special attention ; 
we have seen the blood which had flowed quite freely while the 
tail was hanging pendant, cease almost immediately when the 
animal was returned to his stall, and the tail placed in the position 
to be described on another page. But in case of an unusually 
abvmdant hemorrhage, a simple compressible bandage may be 
applied, to be left on until the bleeding is controlled. 

The treatment appropriate for wounds resulting from incision 
and removal of portions of muscular substance, is that which is 
common to all suppxu'ating wounds, cleanliness being the most 
important item. AVhile such attentions are naturally re quired for 
animals subjected to any of the various methods of operation, the 
subcutaneous mode can claim an important advantage in the fact 
that the heahng process is almost always by first intention, and 
the tail demands no subsequent nursing. 

Whatever may have been the method of operation which the 
animal has undergone, it will be subsequently necessary to place 
the tail in some given elevated position, and retain it in position 
for a term ranging from two to possibly foiu- weeks, or until the 
wounds are cicatrized. Various devices are in use for keeping the 
tail in an elevated position, the simplest and probably the best of 
which is that of the pulleys. The proof is simple ; either a single 
pulley is placed in the middle of the ceiling, or two are used, one 
on each side of the stall, and in either case about on a level with 
the loins of the animal. The tail is kept in the perpendicular 



304 



OPERATIONS ON MUSCLES AND THEIE ANNEXES. 




Fig. 331. —Simple Method to Keep the Tail Elevated. 

position by a cord passing through the pulley, one end being se- 
cured to the tail and the other to a weight sufficiently heavy to 
effect the purpose (Fig. 323). A httle art is necessary in attaching 
the cord to the tail. The hair should be nicely braided and a loop 
formed, and then a small wooden pin run through the braid will 
effectually prevent the cord from becoming detached. This plan 




Fio. 323.— Brogniez's Apparatus to Elevate the TaiL 



CAUDAL MYOTOMY. 



305 




Fig. 323.— Elevating the Tail with Pulleys. 



also has the advantage of equalizing the strain on the hair. In 
respect to the amount of weight to be employed in this process, 
much caution must be exercised in order to avoid excess. An 
error here might cause the loosening and loss of the hair, with 
the troublesome consequences of greatly interfering with the final 
result at the cost also of much suffering to the horse. The cord 
should run freely through the pulley and be of sufficient strength 
to allow the animal to He down if disposed to do so. It will be a 
prudent precaution to accustom the animal to the use of the pul- 
leys by placing them on him for a few hours daily for a short pe- 
riod in anticipation of the operation. It will be necessary — as we 
before remarked — for the horse, after that, to remain in the pul- 
leys not less than two, and possibly three or four weeks, although 
after a short time he may be relieved for the purpose of taking 
proper exercise. The Bartlet's apparatus recommended by G. 
Fleming may also give very good results (Fig. 324). 

Caudal myotomy is an operation, which, though simple in it- 
self, may be followed by numerous and, at times, severe compli- 
cations. Out of one hundred and forty-one animals operated 
upon by Hering, four died from either gangrene, severe petechial 
fever or suppurative infection. Among the most common acci- 
dents met with are the following : 



306 



OPERATIONS ON MUSCLES AND THEIR ANNEXES. 




Fig. 834.— Bartlet's Apparatus, Separate and in Position. 



1st. Hetnorrhage, which is not generally serious, taking place 
mostly when the tail is loosened and allowed to hang down, and 
ceasing as soon as it is again placed in an elevated position. It 
is but seldom that it becomes necessary to interfere for the pur- 
pose of arresting it, which is easily effected by the ordinary 
means, as pressure or the application of hemostatics. 

2d. Gangrene is one of the most dangerous sequelae of the 
operation, whether resulting from excessive traction on the tail 
by the heavy weights, a dressing too tightly appHed, or excessive 
inflammation, or, according to Hering, to the completed* section 
of all the arteries supplying the tail. When becoming gangren- 
ous, the wounds assume a brown or blackish appearance, the sup- 
puration becomes sanious, with a repulsive, sui generis odor, the 
tail is swollen and flabby, and the oedema surrounding is cold and 
puffy. The gangrenous process generally begins toward the end of 
the tail and progresses rapidly, endangering in time the hfe of 
the j)atient. It is often only by the most energetic measures that 
it can be controlled, such as the free use of antiseptics, scarifica- 
tion, cauterization, or even amputation. 

3d. 'Wounds of the Vertehrve and of their Ligaments. — These 
injuries, not so serious in their character, are usually produced 
by the contact of the knife during the operation, causing a 
scraping of the bone and wounding of the jaeriosteum or the 
ligaments which unite the vertebrae. Another injury is a re- 
sulting necrosis caused by the formation of a fistula, from which 
a thin sanious pus is discharged, and which forms a wound which 
refuses to cicatrize. Though Zundel affirms that this complica- 
tion is most common after the subcutaneous operation, long 
experience with this process fails to justify our agreement with 



CAUDAL MYOTOMY. 307 

this assertion. Wheu disease of the bones exists, the indication 
is to promote the exfoHation of the necrosed parts by free open- 
ings, antiseptic dressings, and, if necessary, caustic injections. 
Anchylosis of the vertebrse is a common sequel of this complica- 
tion. 

4th. Abscesses. — These suppuratire collections are not uncom- 
mon, especially in animals having pecuUar idiosyncrasies, as in 
cases of strangles. They may extend to the root of the tail, 
around the anus, or any part of the hind legs even to the rectal 
region. They require treatment similar to that of all analgous 
gatherings. 

5th. Anal Fistulce. -This accident occurs when the first in- 
cision is made so near to the anus that it enables the pus, when 
it forms, to filtrate between the skin and the rectum into the pel- 
vic cavity, and is a condition which can be reheved only by giving 
free exit to the collected suppuration. 

6th. Tetanus. — This termination can, in many instances, be 
avoided by antiseptic measures during and after the operation. 

7th. The introduction of air into the veins is also mentioned 
by Loiset and Brogniez, but in our opinion there is no moi'e reason 
to expect its occiu-rence in this than in any other operation. 

8th. Exaggerated Elevation of the Tail. — This is one of the 
most common of all the sequelae met with. In this case the tail, 
instead of being carried horizontally and hanging gracefully, is, 
on the contrary, either elevated vertically, or even laid back on 
the croup. This is not precisely due to improper manipulations 
during the operation, but is rather the result of the apphcation of 
too heav;y' a weight and an excessive amount of traction while the 
animal is in jJuUeys. The most effectual way of avoiding this un- 
pleasant incident is to watch closely the progress of the cicatri- 
zation by taking the patient out for exercise and watching the 
manner in which he carries his tail, and then increasing or di- 
minishing the weight on the pulley, and shortening or lengthen- 
ing the period of its use. 

Operation for Abnormal Deviation of the Tail. — This is in- 
dicated where there is a lateral curvature of the tail, and the 
animal carries it sidewise, whether it be a congenital habit or 
occvQ's as one of the complications of pricking ; and also when he 
carries it in an excessively elevated position. In these cases 
myotomy is performed, according to the requirements, either on 



308 OPERATIONS ON MUSCLES AND THEIR ANNEXES. 

the lateral caudal muscle on the side to which the tail is carried, 
or upon one or both of the superior sacro-caudal muscles, the 
elevators of the tail. As a rule, one incision only is necessary, 
and it must be done subcutaneously, and in the subsequent treat- 
ment, instead cf placing the animal in pulleys, the tail must be 
tied up to the siircingie on the side opposite to that of the opera- 
tion ; or it may be allowed to hang down free. An experience on 
our part of many years, has rendered us skeptical as to the success 
of lateral caudal myotomy, a careful dissection of the tails of 
animals affected with this deformity having proved the existence 
of an abnormality in the formation and development of the 
caudal vertebrae which has been either the cause or effect of the 
trouble. Operations performed ujDon animals of this class have 
not been usually followed by a satisfactory result. 

CRURAL MYOTASE— CRURAL MYOTOMY. 

This affection is peculiar to bovines, and is a species of dis- 
location, or displacement of the long vastus muscle — the 
external ischio-tihial. It is a lesion which forms a very serious 
impediment to the act of locomotion, by its disabling effect upon 
the movements of the hind leg. 

The nature of crural myotase will be understood by those who 
are familiar with the anatomy of the region in cattle. With them, 
the biceps femoris covers, in its normal position, the whole of the 
coxo-femoral joint, in such a manner that its anterior border {a b), 
Fig. 325, is situated in front of the joint. This border, from 
the articulation to its lower end, forms a kind of tendon, (c) 
closely connected with the aponeurosis of the fascia lata, (f) whose 
divided layers surround the muscle, adhering intimately to its two 
faces, the deep and the superficial. Passing over the trochanter 
of the femur, with the assistance of a large mucous bursa, the 
biceps is quite thin, and is kept in position by an aponeurosis (c) 
which partially covers the gluteus externus, and is united to the 
fascia lata. 

When this aponeurosis is lacerated at a point on a level with 
the hip joint, while the leg is carried backward, in excessive ex- 
tension, it is possible that the trochanter, thus carried forward, 
may become engaged in the laceration, the biceps itself being 
hooked, as it were, behind the trochanter, and prevented from re- 



CEUKAL MYOTOMY. 



309 




Fig. 325.— The Biceps Femoris in Cattle. 
Normal Position. 



Fig. 326.— The same over the 
Trochanter. 



turning in its normal direction. This accident has been noticed 
and mentioned in the remotest ages. It may result from both 
jn'edisposing and occasional causes. Among the former may be 
reckoned the conformation of the animal, as when, for examj^le, 
the croup is short, flat and narrow, the hip joint not prominent, 
and the trochanter high. Among the predisposing causes may 
also be included that of leanness, as when the animal is thin and 
in poor condition, and the cellular tissue deficient. The combina- 
tion of these causes renders it easy for the muscle to slip over the 
trochanter, now relatively prominent, and it is thus that the dis- 
location occurs. 

Occasional causes also call for mention. These include all 
mischances likely to bring about the excessive extension of the leg, 
such as faUs, missteps, shpping, jumping, kicking, blows, etc., 
any of which may thus affect the limb and produce the lesion 
under consideration. And withal, it may take place vnthout any 
visible, direct and efficient agency beyond the circumstance of the 
excessively lean condition of the animal, and even if the difficulty 
is remedied, and the displacement is reduced, while the same 
state of things continues, there is a constant liabihty to a return 
of the difficultv. 



310 OPERATIONS ON MUSCLES AND THEIR ANNEXES. 

The symptoms characteristic of this lesion are readily identi- 
fied. Principally, there is great diflficiilty in flexing the hip joint. 
The diseased leg is dragged on the ground, carried outward and 
backward and the animal resting it on the ground by the point of 
the hoof only. It very much resembles the position of a hmb of 
a horse suffering with a dislocated patella. The anterior border 
of the muscle, hooked by the trochanter, forms a longitudinal 
projection, resembling a stretched cord, which becomes more and 
more marked when examined nearer the coxo-femoral joint. It 
can be made more prominent by raising the opposite leg, when it 
will be found extending obliquely downward from the joint to the 
patella. As the trochanter is no longer covered by the muscle, 
this bony eminence becomes directly subcutaneous, and may be 
readily recognized, holding posteriorly the displaced muscle, 
which forms a kind of tumor behind it. 

These symptoms, being rarely associated with inflammatory 
phenomena, are not always easy to detect. There are cases where 
the lameness, and the carrjT^ng of the leg outward and backward, 
are the only apparent symptoms. The lameness, however, is 
characteristic, and may be temj^orary or intermittent, being more 
severe when the animal is traveling up-hill than when descending, 
but remaining the same on both soft or hard ground ; and it 
sometimes happens that while the animal is in the act of descend- 
ing, the muscle will suddenly return to its place with a clapping 
sound, and the lameness subside, though only to return again as 
soon as the slightest effort is required of the animal, and his hind 
leg is again carried backward more forcibly than usual. This 
peculiar intermittent character is sometimes the cause of an error 
of diagnosis which confounds this affection with the dislocation 
of the patella, but the exploration of the stifle will always serve 
to establish the differential diagnosis. 

This accident is more or less serious in its consequences, and 
is particularly detrimental to the usefulness of working animals. 
It may sometimes, however, subside spontaneously or by simple 
rest, and especially if the condition of the animal is improved by 
good feeding with fat-producing fodder. Sometimes the displace- 
ment is comjDhcated by a laceration of the mucous bursa with the 
formation of a hygroma of warm, painful, oedematous swellings, 
indicating the rupture of the aponeurosis or the inflammation of 
the cellular tissue. 



CEUEAL MYOTOMY. 311 

Generally the dislocation is unilateral, but in other cases it may- 
occur in both legs. This last condition is always of a serious 
nature, and seldom responsive to treatment. The displacement of 
the biceps femoris seldom recovers naturally, although where in- 
complete and intermittent, it may be benefitted by long rest, or 
when, as we have before remarked, it is due to the excessive lean- 
ness of the patient, in which case a hberal fattening diet will prove 
the best remedy, by removing the cause of its appearance. Local, 
external topical treatment by bUsters, plasters, setons, etc., are of 
no avail. The section of the muscle or the operation of crural 
myotomy, is the indication. The modus operandi is not uniform, 
although the final object is the same in all. 

Our opinion in respect to the best way of operating is in favor 
of that by the subcutaneous section. This is performed below the 
trochanter, and yet as near to it as possible, where the excessive 
tension of the hooked muscle can readily be felt. This consists 
simply in making a small incision through the skin, by which to 
introduce a blunt bistoury, which is inserted under the muscle, 
with a director or a finger for a guide, and when at a proper depth 
turned to bring the sharp edge towards the aponeurosis, and cutting 
it from within outward, carefully avoiding the section of the skin. 




Fig. 327.— Gouze's Bistoury. 

The bistoury invented by N. Gouze answers the purjjose very well. 
There is no after-treatment required beyond the ordinarj^ care re- 
quired for all wounds. 

Simple as the operation of crural myotomy is, some compHca- 
tions may accompany it. 

Hemorrhage is not uncommon, usually subsiding without inter- 
ference, but sometimes requiring the appHcation of hemostatics. 

Inter-3Iuscnlar Abscesses. — Diffused Suppuration. — These are 
the result of improper manipulations during the operation, such 
as lacerations of the cellular tissue by introducing the fingers too 
frequently into the wound, or dividing the muscle in several places. 

Gangrene. — Though but rarely met with, this should be re- 
membered among the possible contingencies. It may occur as the 



312 OPEKATIONS ON MUSCLES AND THEIR ANNEXES. 

result of the presence of clots of blood or other mortified tissues 
in the wound, and is indicated by the bad appearance of the parts, 
the pecuhar oedematous swelling, first warm and painful, but sub- 
sequently becoming cool and painless. This condition requires 
prompt and efficient treatment, both external and internal. 

In Sollpeds. — We once had occasion to resort to crural myotomy 
for the rehef of a case of pseudo-dislocation of the patella of several 
months' standing. The division was made towards the lower por- 
tion of the muscle, and was followed by satisfactory results, though 
not immediately. 



OPERATIONS UPON FIBROUS TISSUES. 

Tenotomy. 

In the terminology of surgery, tenotomy means the section of 
tendons — an operation which contemplates the correction of de- 
formities, from whatever cause they may proceed; the relief of 
pressure upon exostoses, and the prevention of the complete execu- 
tion of a normal function, as that of flying in birds. Our atten- 
tion wiU, accordingly, be directed to the study of the five varieties 
of plantar, carpal, antibrachial and tarsal tenotomy, with that of 
the wings of birds. 

Plantab Tenotomy. 

This operation is the proper remedy for the deformity known 
as knuckling, or the malposition which arises from the exaggerated 
flexion of the fetlock joint, and consists in the subcutaneous section 
of the tendons of the flexor of the phalanges. 

In this affection of knuckling, which is mostly pecuhar to 
soHpeds, there is lameness more or less marked, with a hard and 
painful enlargement of the tendons, and a consequent interference 
with the act of locomotion, caused by an incomplete flexion of the 
articulations. The fetlock is carried forward, and contact with the 
ground is effected with the toe alone. 

Instances of spontaneous cure or abatement are exceedingly 
rare. On the contrary, it has a tendency to aggravation, the swell- 
ing increasing, and the deformity becoming by degrees more and 
more developed, until at length the anterior face of the wall of the 
foot rests on the ground, and the case assumes all the weU estab- 



OPERATIONS UPON FIBKOUS TISSUES. 313 

lished characters of a recognized club-foot. In a majority of cases 
the disease is locahzed in the tendon of the deep flexor of the 
phalanges, but it often extends to the superficial tendon as well, 
or may involve the tarsal or carpal band, or the suspensory ligament. 

This deformity of knuckhng may exist in three different degrees : 
either the cannon bone and the phalanges meet in an almost ver- 
tical hne, as in the case of the animal straight or upright on his 
pasterns, which is the first degree ; or the bones meet to form an 
angle opening backward, the phalanges being somewhat oblique 
in that direction, instead of forward, as in the normal state, and the 
animal still resting on the entire plantar surface of the foot, which 
is the second degree ; while in the third degree these conditions are 
still more exaggerated, the animal traveling altogether on his toe and 
exhibiting a case of the perfect talipes. This last conformation, 
which exists principally in the hind legs, is specially due to the 
retraction of the deep flexor, while in the other degrees it is the 
superficial flexor which is diseased. Lesion of the suspensory 
ligament may coexist in either case. 

The condition of the tendons, from which this deformity arises, 
is not the only question to take into consideration when the j)i"0- 
priety of the oj)eration is to be determined. The causes which 
have produced it must not be overlooked. For example, while in 
the hind legs the accident has usually a traumatic cause, such as 
a sprain, violent over-exertion, lacerations, or contusion of tendons ; 
when the fore legs are affected it is most commonly as the accom- 
paniment of some lesion in other parts of the leg, as of the foot 
or the digital region proper, such as bad feet, navicular disease, 
contraction of the heels, corns, quarter and toe-cracks, quittors, 
deep punctured wounds, and very commonly ringbones, or other 
exostoses. 

Taking all these various causes into consideration, with their 
specific natiu'es, and the extent of the lesions which accompany 
them, we are justified in believing with Gourdon, that plantar 
tenotomy is indicated with fair chance of success, when the knuck- 
hng results from traumatism, and the perforans tendon is alone 
diseased ; and even when both tendons are affected, good results 
are still not improbable ; but that it is contra-indicated whenever 
complications exist which are likely to prevent the leg from re- 
turning to its natural position, as when the disease is of long 
standing ; when there are alterations of the articular surfaces ; 



314 



OPEEATIONS ON MUSCLES AND THEIR ANNEXES. 



anchylosis of the fetlock ; exostoses ; adhesions between the ten- 
dons and the bones ; large engorgements of the tendinous struc- 
ture ; or chronic dilatation of the synovial btirsse surrounding the 
region of the fetlock. Remediable cases would seem, from this, to 
constitute rather a small minority of the whole number. 

The fibrous tissues acted upon in plantar tenotomy, are the 
tendons of the flexors of the phalanges, in that part of their length 
which is situated back of the cannon bone, between the carpal or 
tarsal sheath and the fetlock. The superficial tendon reaching the 
fetlock forms a ring through which the deep flexor passes, a cir- 
cumstance from which has been devised the manner of perforatus 
and perforans, by which they are known. 




Fig. 328.— Median section at the infe- 
rior row of the carpus — of the metacar- 
pus and suspensory ligament. 

1. Os magnum. 

2. Posterior common ligament of the 
carpus. 

3. Band to the perforans. 

4. Suspensory ligament. 

5. Its superficial layer. 

6. The deep. 

7. Principal metacarpal bone. 



The superficial tendon is covered by the fibrous expansion of 
the two cai-pal and metacarpo-phalangeal sheaths in the fore, and 
by the tarsal and metatarso-phalangeal in the hind leg. The deep 
flexor toward the middle of the cannon receives a strong, fibrous 
band coming from the posterior Ugament of the carpus or tarsus. 
Below and between the two small metacarpal or metatarsal bones 
is the suspensory ligament, a strong band, thin superiorly at its 
origin, and bifid inf eriorly. Between the suspensory ligament and 
the cannon bone, there is an interosseous vein and the two inter- 
osseous arteries ; on the side of the tendons, the internal and ex- 
ternal collateral veins, with, in the fore leg, the principal artery 



I 



OPERATIONS UPON FIBROUS TISSUES. 315 

collateral of the cannon., and the internal plantar nerve as its 
satellite on the inside, and the external plantar nerve on the out- 
side of the leg; whUe on the posterior leg the iirincipal artery of 
the cannon, which is the collateral metatarsal, is situated on the 
outside of the bone, and comes in relation with the tendons only 
in the lower part of the metatarsus. 

In the anterior legs, the carpal bursa, lined with its synovial 
sac, extends downward on the flexor tendons as far as below the 
superior third of the metacarpal region ; the synovial vaginal sac 
of the sesamoid sheath runs upward along the tendons, as far as 
the lower extremities of the small metacarpal bones. It is at about 
the center of the middle third of the cannon that the operation 
can be performed without fear of injuring either of these synovial 
sacs. 

In the hind legs the tarsal sheath extends as far as the upper 
part of the middle thuxl of the metatarsal region, and the sesamoid 
sac being the same as in the anterior leg, a little larger space is 
left for the operation. 

Modus Operandi. — To perform plantar tenotomy, the animal 
must be thrown. Some practitioners operate with the horse on 
his feet, but this position is dangerous, although by the use of 
cocaine, much of the risk attending it may be obviated. The 
animal is thi'own on either side, according to the leg upon which 
the operation is to be performed. If on the fore leg, it must be 
on the side of the leg to be operated on in order to expose the 
inside of the Hmb ; if on the hind leg, the animal should be thrown 
in such a manner as to make the leg upon which the operation is 
to take place the upper one. The arrangement, according to 
Gourdon, makes the operation feasible both on the inside of the 
fore, and the outside of the hind leg. 

Several modes of proceeding have been practiced. The old 
method is by a large lateral incision, in which the tendon is ex- 
posed, divided either with a bistoury, or by being raised from the 
wound and then di\ided. But this style of procedure necessitates 
the formation of large wounds, and is liable to severe and trouble- 
some comj^lications, which the modern or subcuta?ieoi(s method 
obviates. 

In performing the subcutaneous division, two instruments are 
necessary. These are the straight and curved tenotomes. The 
blade of the former is narrow, straight, thin and pointed ; that of 



316 OPERATIONS ON MUSCLES AND THEIR ANNEXES. 




Fig. 329. Straight Tenotomy Knife. 




Fig. 330.— Curved Tenotomy Knife. 

the latter narrow, curved and blunt, and sharp on its concave 
edge. 

The animal being prepared, a puncture of the skin is made over 
the tendinous region (carefully avoiding the synovial sacs, as men- 
tioned above), by introducing the straight tenotome perpendicu- 
larly between the tendons, until the point of the instrument is felt 
on the opposite side of the leg. A slight sawing motion of the 
instrument then cuts through the connective tissue which unites 
them, and permits the introduction of the curved tenotome into 
the tract made by the straight instrument, and the latter is slowly 
withdrawn. At this point the leg is carried into excessive exten- 
sion by the assistants, by means of ropes secured respectively, 
one about the knee, and one about the foot, and pulling that of the 
knee backward and that of the foot forward. The fetlock being 
thus stretched to its utmost, the operator, with the edge of the 
curved tenotome turned toward the deep flexor, makes a slight 
sawing motion with the instrument, and cuts through the fibrous 
structure from behind and forward, a peculiar crackling sound in- 
dicating when the section is accomplished. The retracted extrem- 
ities of the tendons can now be felt with a wide interval between 
them, and the straightening, more or less, of the fetlock gives fur- 
ther proof that the operation is completed. 

This is the method in simple tenotomy. Some operators have 
suggested the introduction of the instrument between the sus- 
pensory ligaments and the perf orans in preference to the mode we 
have described, in which case the section of the tendon must be 
made from before backward. It is, however, a complicated pro- 
cess, and one which is not without danger of injuring tissues 
which ought to be left intact. The mode of operating known as 
the Bernard method is based on this principle. 

The double tenotomy, though considered at first as a severe 



OPERATIONS UPON FIBROUS TISSUES. 317 

operation, does not involve as many objections as at first thought, 
but, on the contrary, has often been followed by very satisfactory 
results. It is, therefore, a justifiable operation when the defor- 
mity of the fetlock is quite extensive. In fact, it is unavoidable 
when both tendons are united, or when the deviation in the di- 
rection of the bony levers is caused equally by the common con- 
traction of both. In performing this double tenotomy, the divis 
ion of the deep flexor being made by the manipulations already 
described, the curved tenotome being still retained in the wound 
between the tendons, the operator simply reverses its position in 
order to bring the cutting edge in contact with the superficial 
tendon, and completes the operation precisely as ah'eady described. 
In this division of the tendon great caution must be observed, in 
order to avoid making a complete transverse section of the skin. 
Double tenotomy is also performed in some cases by introducing 
the tenotome between the suspensory ligament and the tendons, 
and dividing them by a section made at once through both from 
before backward. 

In some peculiar cases, besides the division of the two tendons, 
that of the suspensory ligament has also been included, sometimes 
in connection with the tenotomy, and sometimes independently. 
In this case, the place selected differs from that which is indicated 
for the simple or double operation. It is, indeed, toward the lower 
extremity near the bifiu'cation, and toward the lower third of the 
cannon, where it is more readily reached. The straight tenotome 
is first introduced, flatwise on either the internal or external face 
of the leg, between the ligament and the deep flexor of the pha- 
langes, carefully avoiding the blood vessels and nerves, and the 
curved instrument is inserted with its cutting edge toward the 
ligament, the section being made by cutting from behind forward. 
The instrument must not be introduced between the bone and 
the ligament, nor must the section be made from before back- 
ward ; such a course not only endangering the nerves and blood 
vessels, but also involving the risk of breaking the blade of the 
tenotome at the bottom of the wound. 

Whatever mode may have been followed, and however many 
tendons may have been divided, or whatever force may have been 
apphed to the rope by the assistants who made the traction, it is 
an exceedingly rare result to obtain a perfect straightening of the 
leg, most especially when the disease has been of long continu- 



318 



OPERATIONS ON MUSCLES AND THEIR ANNEXES. 



ance, and chronic adhesions may exist. A short walking exercise 
following the operation may facilitate the straightening of the leg, 
and in any event can have no injurious effect. But even with this, 
it is sometimes several days before any well-marked improvement 
can be discerned. There are cases, indeed, when ten or fifteen 
days may pass without noticeable change, but if it fails to appear 
after such a lapse of time, the case may be considered hopeless. 

There are practitioners, however, among whom are Didot, 
Delward and Hering, who object to this exercise, and hold that 
the natural and spontaneous 
straightening of the fetlock 
can be greatly assisted by 
proper shoeing, as, for exam- Fig. 332.— Mov- 

11 • 1 .11 able Toe-Cork. 

pie, by weanng a shoe with a 
long toe, such as are used in cases of club- 
foot, or again, by having pecuHar movable 
toe-corks by which the effect of the bearing of the shoe is in- 
creased. The ordinary long-toed shoe represented in Fig. 333 
is often worn with advantage. 




Fig. 331. — Shoe with Pro 
longed Toe, for Cluh-Foot. 




Fig. 333.— Long-Toe Shoe. 

Complete rest after the operation will benefit the patient in the 
most essential manner by diminishing the causes of pain and f avoi*- 
ing the cicatrization, and possibly preventing an exaggerated ex- 
tension at the fetlock. It is only after from twenty to twenty-five 
days that moderate exercise may be allowed, and not less than six 



OPERATIONS UPON FIBROUS TISSUES. 



319 



weeks should elapse before the ordinary labor of the patient can 
be resumed. The resulting wound needs no special dressing, and 
by being thoroughly sterilized by antiseptic manipulations, the 
parts will heal without trouble. The suggestions of poultices, 
fomentations, counter irritation, blisters and firing of old-time 
surgery must be strictly ignored. 

If, however, all the measures recommended for the straighten- 
ing of the leg should fail, and, on the contrary, a tendency to an 




Fig. 334. FiO. 335. 

Figs. 331, 335, 336.— Various Apparatus Recommended after Tenotomy. 

excessive extension of the fetlock should be manifested, the appli- 
cation of some of the various kinds of apparatus designed for the 
correction of these defects may be experimentally tried, with a 



320 



OPERATIONS ON MUSCLES AND THEIR ANNEXES. 




Fig. 336. 



possibility of good results. According to 
their peculiar working arrangements, slowly 
increased extension might be maintained? 
or the leg might be steadily retained in a 
given position, or with the power of regu- 
lated motion, the result being an important 
and permanent improvement in the value 
and comfort of the animal. 

The accidents which may be apprehend- 
ed in connection with plantar tenotomy are 
he^norrhage and wounds of nerves, or of 
the skin, or of the synovial sacs / an exag- 
geration of the extension, and a return of 
the original deformity. To these Peuch 
and Toussaint add gangrene. 

{a) Hemorrhage, both arterial or vein- 
ous. But this may be avoided by careful 
attention to the rules laid down for the operation, and if it should 
occur, hemostatis by pressure must be resorted to, and the band- 
age can be safely removed, or at least the pressure diminished, in 
from twelve to twenty-four hours. 

{h) Wounds of Nerves. — These cannot very well be avoided, 
and while they are manifested by severe struggles of the animal 
at the moment of their occurrence, they involve no danger other 
than those pertaining to similar injuries in other regions, viz.: the 
temporary suspension of the sensorial functions. 

(c) Wounds of the Skin. — These are among the comparatively 
severe compHcations, and when they occur, they destroy aU the 
advantages which properly accompany the operation as a subcu- 
taneous process. They are likely to compHcate the operation with 
fungoid growths upon the stumps of the tendons, abundant sup- 
puration, ugly cicatrices, etc., and should therefore be specially 
guarded against. 

{d) Wounds of the Tendinous JBursoe. — These may be attrib- 
uted to an improper selection of the place where the puncture 
should be made, and may be recognized by the flow of synovial 
fluid from the wound. Suppurative synovitis may then complicate 
the case with fatal effect. The treatment they require is that 
directed for open synovial tumors. Local appUcations, rest, pres 
sure, counter irritation, bhsters and firing are the indications. 



OPERATIONS UPON FIBROUS TISSUES. 321 

(e) Exaggeration of the Extension. — This may take place 
when artificial means to produce sudden extension are too power- 
ful, or when the violent efforts of the animal have caused a ten- 
dency in the j)arts to give way suddenly. The apparatus before 
referred to must be here brought into requisition. 

(/) Return of the Original Deformity. — This results from 
the retraction of the new tissue formed between the stumps of 
the divided tendon. It occurs as a consequence of returning the 
animal to his work at too early a date, and when the newly formed 
tissue has not yet become sufficiently matured and solidified to 
sustain the strain to which it had been subjected. Rest, cold 
water bathing in a running stream, vesicating applications and 
firing have been recommended as remedies, and even a second 
section of the tendon may be suggested, though with but a doubt- 
ful prospect of good results. 

Carpal Tenotomy. 

This defines the section of the tendons of the external and 
oblique flexor muscles of the metacarpus. They are inserted on 
the trapezium bone of the carjDus, and their retraction occasions 
the deformity known as sprung knees, a condition brought on by 
excessive and exhaustive labor, though there is a class of pa- 
tients in which the lesion may be ascribed to a congenital taint, 
and it is principally for the benefit of this class of patients that 
the operation is indicated and usually perfonned. It is principally 
favored and utilized in Germany, where it was originated by 
Dieterichs, though afterwards adopted and practiced by Prud- 
homme, Lafosse, Miguel, Brogniez, Hering, Gourdon and others. 
The operation can be performed on either tendon singly, or on 
both ; but according to Hering, the division of the external mus- 
cle is generally sufficient. 

The anatomy of the region should be described before passing 
to a detail of the steps by which the section of the tendon is ef- 
fected. The external flexor is situated on the posterior external 
part of the forearm, and terminates by the branches, one of which, 
the funicular, is anterior, and passing in the groove of the external 
face of the trapezium, becomes attached to the hand of the exter- 
nal rudimentary metacarpal bone ; while the other posterior, wide 
and short, goes to the supero and posterior circumference of the 
same bone, in connection with the middle flexor, to which it is 



322 OPEBATIONS ON MUSCLES AND THEIR ANNEXES. 

united. The section must be made above the bifurcation of 
the tendon, to avoid the artery which passes under it, though 
it is quite deeply situated, and besides, there is no danger 
of injuring the synovial sac of the carpal arch. The obhque 
flexor is situated back and inside of this, and has its tendon single, 
terminated on the trapezium, with the posterior tendon of the 
external flexor. The section must be made before the union of 
the two tendons, in order to avoid injury to the carpal arch. 

The animal is thrown, and the knee extended with two ropes, 
one above and one below the knee, and drawn in opposite direc- 
tions. The same instruments are used for carpal as for plantar 
tenotomy. 

The incision of the skin is made about two inches above the knee 
with the straight tenotome, immediately in front of the tendon, 
which is easily felt under the skin, and is raised with the fingers ; 
the curved tenotome is inserted between the skin and the tendon, 
from before backward, and the section made as in the plantar 
operation. Gourdon suggests the introduction of the knives 
under the tendon instead of between that and the skin. By this 
mode the division is made from within outward, while in the 
other way it is made from without inward. 

The external flexor being thus divided, the section of the 
middle flexor is made a httle below ; the puncture of the straight 
tenotome is made between the two tendons, and the curved 
tenotome inserted as before, between the skin and the tendon 
from before backward, or preferably, from without inward, and 
when its blunt end is felt on the posterior border of the muscle, 
the section is made from without inward, with the usual motion of 
the knife. Only a simple dressing is required, but the animal 
must be kept at rest for at least a month. 

The modus ojyerandi to which we give the preference over that 
which we have just narrated, and which we have described in our 
work on lameness, is very simple. The animal being thrown, on 
the side opposite to that of the operation, and the knee extended 
as usual, the operator, who is in front of the knee, feels for the 
space between the two muscles, where they are about to unite, 
and this being found, a straight tenotome is introduced through 
the skin from before backward, about two inches above the super- 
ior border of the trapezium, and under the thickness of the 
middle flexor, and when the point of the instrument is felt on the 



OPEKATIONS UPON FIBROUS TISSUES. 323 

other border of the muscle, in front, the curved tenotome is in- 
serted and the straight one withdrawn, and the tendon di-vided 
from within outward ; the straight tenotome is then re-introduced 
through the same opening, between the muscles, and carried from 
behind forward on the posterior border of the external flexor, 
under its thickness, until the point of the instrument is felt on 
the anterior border, when the curved tenotome is again re-insert- 
ed, and the division of the tendons performed as before. The 
wound of this operation is simple, heals readily, and is Hable to 
no complications or accidents. Of course the operator must ex- 
ercise due caution, when dividing the tendons from within out- 
ward, to avoid making a complete section through the skin. 

Anti-Bra.chial Tenotomy. 

This operation has been recommended for the relief respec- 
tively of sprung knees and knuckled fetlocks, but by reason of the 
numerous and almost constant failures by which it was character- 
ized, has been discredited, and banished from the domain of our 
surgery. It consisted in the section of the tendinous band which 
from the lower extremity of the coraco-radialis extends downward 
to mingle with the fibres of the anti-brachial aponeurosis, in pass- 
ing a little below and in front of the elbow joint. 

Brogniez, who recommended the operation, performed it by 
making a longitudinal incision of the skin over the course of the 
tendon, which is readily felt under the skin, and passing the point 
of a convex bistoury over the aponeurosis and the band, dividing 
it from without inward. 

Taesal Tenotomies. 

Two modes of operation are practised upon some of the 
tendons sm-rounding the hock joints, one upon the cunean branch 
of the flexor metatarsi muscle, the other upon the tendons of the 
lateral extensor of the phalanges. They are known distinctively 
as the cunean and the peroneo-phalangeal tenotomy. 

{a.) Cunean Tenotomy. — The flexor metatarsi, one of the 
muscles of the anterior tibial region, is composed of two por- 
tions, one muscular, the other tendinous. The tendinous portion 
is situated between the muscular portion and the anterior extensor 
of the phalanges, and is attached above to the inferior extremity 
of the femur, between the external condyle and the external 



324 



OPERATIONS ON MUSCLES AND THEIK ANNEXES. 



border of the trochlea of that bone, and passes in the groove 
situated between the anterior and external tuberosity of the 
superior extremity of the tibia, downward to the hock, where it 
rests on the anterior face of that joint and is attached by two 
branches, one to the cuboid, on the outside of the hock, the other 
to the superior extremity of the principal metatarsal bone. The 
muscular portion, which rests on the external face of the tibia, 
from the upper part of which it takes its origin, terminates in- 
f eriorly by a tendon which passes through a ring of the tendinous 
portion, and becomes more superficial, and then divides into two 
branches, a large one, which goes to the superior part of the 
principal metatarsal bone, in uniting with that of the tendinous 
portion, and another, smaller, which bends inward, to terminate 
at the small cuneiform bone. This branch is chosen as the seat 
of operation. 

The operation recommended by Abildgaard and Viborg, was 
indicated by Hertwig, and at a later period performed by Lafosse, 
Hering, Mantel, Grad, Bugniet and Dieckerhoff. It is very com- 
\ monly performed on this continent, and, 

like many other operations at the time 
of their first introduction, has been both 
used and probably abused to such an ex- 
tent that it has not yet received the credit 
to which it is fairly entitled. 

It is indicated for the relief of the pres- 
sure which this branch makes upon the 
distended periosteum of the enlarged tar- 
sal exostoses known as spavins, and when 
the exostosis is, strictly speaking, the only 
lesion in the hock, it will prove essen- 
tially beneficial. But if, with the new 
growth of bony deposits, the joint itself 
Fig. 337.— Cunean Brancb of the should be involved, and some of the ar- 
piexor Metatarsi. ticular diseases should be present, the 

result, so far as the removal of pain and lameness is concerned, 
is not always certain. Although more or less satisfactory at times, 
in many instances it entirely fails. The difficulty of positively 
diagnosing the condition of the articular surfaces justifies the 
surgeon in operating, when the tense condition of the tendon, its 
pressure upon the exostosis, and the irritation of the synovial sac 




OPERATIONS UPON FIBROUS TISSUES. 



325 



whicli aids its movements, which it produces, point with certainty 
to the cause of the lameness. 

The instruments necessary are scissors, a straight and a con- 
vex bistoury, a dissecting forceps, a curved director, and perhaps 
a curved tenotomy knife. 

The animal is cast on the side of the leg to be operated upon, 
the upper leg carried forward and secured on the upper forearm, 
and the hair cHpped over the tract of the tendon, which can be 
readily identified by an oblique groove generally found running 
on the upper portion of the bony enlargement. An incision 
about two and a half inches long is made with the convex bis- 
toury, either parallel to the tendon, or slightly obhque, and right 





Fig. 338.— Tarsal Tenotomy. Cunean 
Tendon Exposed. 



Fig. 339.— Tarsal Tenotomy. The 
Tendon Raised, 



across its direction. This incision is generally accompanied by a 
somewhat troublesome capillary hemorrhage, which ought to be 
controlled before proceeding further. The tendon may then be 
felt through its bursa, which is raised with the dissecting forceps 
and opened, when the tendon is readily exposed. The curved 
director is then inserted under the tendon, which is easily raised 
from its tract, and by guiding the tenotome along its groove the 
section is made by a single stroke. 

Some practitioners complete the operation by amputating a 
portion of the tendon. This is unnecessary, and complicates the 
operation by subjecting the parts to the necessity of a repairing 



326 OPERATIONS ON MUSCLES AND THEIE ANNEXES. 

process, wliich is not needed for the result of the operation, and 
exposes the animal to a complication of inflammation of the 
synovial bursse which ought to be avoided. To obviate these 
dangers, Dieckerhoff is of the opinion that the division of the 
bursa is all that is required, and states that he has often secured 
good results, from that alone, without the section of the tendon. 

Besides this mode of operating, which may be called the open 
incision, there is another procedure by subcutaneous division, 
which is also recommended by some, but the difficulty of discover- 
ing the tendon in its bony groove, and in reaching it properly, and 
the possible compUcation of subsequent inflammation of the bursse, 
will probably secure the preference for the method by open incis- 
ion. The operation is completed by closing the wound with a 
stitch of suture, and protecting it with antiseptic dressings. The 
results of the operation are sometimes immediate, though in some 
cases not apparent for a few days, but if after the lapse of two or 
three weeks the lameness has not either disappeared or greatly 
abated, it may be safely concluded that it is attributable to some 
cause other than the pressure of the tendon. 

( 5. ) Peroneo - Phalangeal Teiiototny. — Though the true 
pathology of the peculiar affection of the hock joint known as 
springhalt, and the cause that excites the spasmodic action 
characterizing it, are far from being satisfactorily known, it has 
been observed that in animals thus affected the tendons of the ex- 
tensors of the foot in front of the hock have a tense or rigid 
character, which renders them unusually prominent ; and it is this 
symptom which suggested to Brocar, a Belgian veterinarian, the 
division of the tendon of the lateral extensor of the phalanges, or 
peroneo-phalangeal muscle, as a means of cure Brocar, Brogniez, 
and Delwart performed it, and have recorded their success in 
numerous cases. 

The lateral extensor of the phalanges terminates inferiorly by a 
round tendon, which passes into the groove situated on the out- 
side of the lower extremity of the tibia, in a sheath formed at the 
expense of the superficial external ligament of the tibio- tarsal 
joint. In this sheath it bends forward and downward to join the 
tendon of the anterior extensor toward the middle of the metatar- 
sus, which it crosses downward, forward and inward. 

The operation is of the simplest nature, and may be performed 
with great facility. The animal being cast, and the section com- 



OPEKATIONS UPON FIBROUS TISSUES. 327 

pleted through a small incision made over the tendon, a little be- 
low the hock, and near its junction with the principal extensor, 
about one inch of the tendon is removed. Sometimes the action of 
springhalt ceases at once, when the animal is allowed to rise to his 
feet. Other cases require a few days for the completion of the 
cure. The simple operation has proved satisfactory in our hands 
in two cases. 

Tenotomy in Birds. 
The operation is performed in this instance with the object of 
preventing the animals from flying, and consists in the section of 
the tendons of the extensor muscles of the carpus and phalanges. 
The bird is held by an assistant, with its wing extended, and a 
few feathers are pulled out from each side of the carpal joint, as 
well as in front of the radius, to expose the skin, through which 
the extensor tendons, two in number, are readily seen. A small 
incision being made through the skin, the tendon is raised with 
forceps, and a portion of it amputated, the operation being re- 
peated on the other side of the wing upon the extensor tendons 
of the digits, between the radius and the cubitus. The treatment 
is appHed to both wings ; it is without hemorrhage, and the 
wounds heal in two or three days. 



CHAPTEK VIII. 

OPERATIONS ON THE DIGESTIVE 
APPARATUS. 

ON THE TEETH. 

The office fulfilled by the dental system in the preliminary 
preparation of the iagesta, and the first step in the process of di- 
gestion, is necessarily one of the utmost imjjortance. Of course, 
therefore, any diseased conditions which may interfere with its 
efficient action, especially with the herbivorous animals, become 
matters of deep interest to the veterinary practitioner. All facts 
and circumstances concur to establish and substantiate the claims 
of that branch of veterinary science which refers to the care 
of the teeth as a very important specialty, and we shall, there- 
fore, so estimate and so elucidate the subject of veterinary dentis- 
try, so successfully studied and so largely developed in recent 
years by American veterinarians. 

The diseases of the teeth to which our domestic animals are 
subject may be due to various pathological conditions. The den- 
tal arches formed by their arrangement ia the jaw may be the 
seat of congenital deformity; the teeth may possess abnormal 
quahties in respect to their number, their shape and their direc- 
tion ; or, again, in the condition of their grinding surfaces, and 
there may also be special diseases of the elementary substances 
of the tooth itself.* 

The abnormality which exists in relation to the number of the 
teeth is of not iincommon occurrence in horses, in which animal we 
sometimes discover the presence of supplementary molars, resulting 
either from the persistence of a temporary tooth which has failed 
to be shed at the proper time, or may be due to an excess of de- 
velopment in the evolution of a dental foUicle, as we may observe 
in the formation of the wolf tooth. 

In relation to the shape of the dental arches, there are cases 

* We take pleasure in recommending, in connection with this subject, the excellent 
little work on Horses' Teeth, written by Mr. William H. Clarke. 



OPERATIONS ON THE TEETH. 329 

where, instead of presenting the regular and correct natiu-al lines, 
the upper and lower molar arches so far disagree as to render 
their perfect coaptation impossible, and render the execution of 
their function to a great extent impracticable. The direction or 
implantation of the teeth is, at times, so far irregular and abnor- 
mal as to change the frictional surfaces in such a manner as to 
remove the wear and abrasion from the crown to the surface of 
the organ. In relation to the disposition of their rubbing sur- 
faces, it is well known that on account of the difference existing 
in the consistency and power of resistance, two of their elements, 
the enamel and the dentine, their frictional surfaces become rough, 
irregular and sharp; and, as they sometimes assume excessive 
dimensions, they may give rise to serious phenomena, especially 
when they have theu- seat in a part of the dental arch where no 
resistance can be offered to their development, as when the cor- 
responding tooth of the opposite jaws becomes diseased or absent. 

The special diseases of the elementary constituents of the teeth 
exist in the depth of their substance, and consist in caries or ul 
aeration of the tooth, the affection involving the dental pulp itself, 
with other diseases pertaining to the alveolo-dental membrane, all 
of them being accompanied by a series of well understood symp- 
toms, severely distinctive in their character, and which in the ma- 
jority of cases call for the assistance of the veterinary dentist in 
order to relieve the suffering animal from the distress in which 
his human master knows but too well how to sympathize. 

The symptoms pertaining to the various conditions above al- 
luded to may be either common, or general, or special. Among 
the general symptoms, the first to be observed is a change in the 
style of performing the function of mastication, proportional to 
the sensitiveness occasioned by the dental lesion. Thus it is ob- 
served that although the animal seizes his food with the same 
avidity as if his teeth were in good order, the motion of his jaws, 
the chewing of the food, are slowly and carefuUy performed, the 
lateral movements of the lower jaw occurring in a hesitating man- 
ner, and often made on one side of the mouth only. In eating 
hay, the mouthful of the food is never triturated as it ought to 
be, and before the process of mastication is completed the animal 
drops it out of its mouth in the shape of a flattened bolus, satu- 
rated with saliva, to seize it again and make a new attempt at 
mastication, perhaps twisting his jaw in different directions in his 



330 OPEEATIONS ON THE DIGESTIVE APPARATUS. 

endeavor to accomplish tlie act without pain. The attempt seems, 
however, to be vain ; again the mouth is opened and the same 
flattened bolus is dropped in the manger, and this continues until 
the poor animal, suffering and hungry, is seen standing before a 
rack full of hay for which he both longs and fears to touch. The 
suffering horse will sometimes swallow his oats imperfectly mas- 
ticated, but the partial chewing is performed slowly and with dif- 
ficulty, his manner indicating the pain it costs him ; dipping his 
nose in the manger, chewing on the grain for a long time, and 
impregnating it with saUva before he swallows it. Soft food, bran 
and mashes, cooked roots, scalded grains, and the like, are the 
only aliments that can, without difficulty with this imperfect de- 
gree of mastication, enter into the pharynx. 

Animals suffering with diseases of the dental apparatus are 
often affected with coHcs. At first they may be slight and inter- 
mittent, but they soon become more severe and more frequent. 
They may last for several days, and may be marked by the pecu- 
liarity^ that during their continuance defecation may still continue, 
though irregular as to time, and the movements scanty in amount, 
the foeces besides being in small and adherent lumps, and more 
or less coated. In other cases they are soft, and the animal has a 
tendency to be washy, and more or less to scour, but in either 
case the droppings are more or less loaded with unmasticated 
food. All these symptoms are manifestations resulting from an 
imperfect digestion. 

It is easy to understand that if this condition continues for 
any length of time the entire economy will suffer from it. The 
animal looses flesh ; his coat becomes dull, dry and staring ; his 
force and ardor diminish ; he sweats easily, and aU his other func- 
tions exhibit evidences of the weak condition of an organism de- 
prived of the nutrition and strength which follow the ingestion of 
food thoroughly masticated and well digested. 

Having recognized these symptoms, which, if not seen by the 
surgeon, should be brought to his attention through the history 
of the patient; when intelligently stated, the diagnosis may be 
considered established. But it becomes positive only after an 
examination of the mouth, by which the special symptoms per- 
taining to each alteration are elicited. 

The inspection of the moath, which may be kept open by the 
use of the various speculums, or by merely pulling the tongue 



OPERATIONS ON THE TEETH. 331 

sidewise out of the way, will, in a gi-eat majority of cases, easily 
lead to the detection of the cause which interferes with masti- 
cation. 

First of all, when the mouth is opened, a peculiar symptom 
will be observed, consisting in a change in the salivary secretion. 
This will be increased more or less, and as the saliva will escape 
freely, a pecuHar acid odor will be noticed proceeding from it, and 
on looking for the cause of this trouble, if it be one or other of 
the irregularities already mentioned, such as the projection of one 
of the teeth, the vicious inclination of their crowns, the sharp 
edges, etc., critical inspection wiU soon reveal them. The teeth 
will be found to be soiled with greenish food-detritus on the side 
where the difficulty exists, and on that same side the animal will 
be found to have stored the surplus food which he has accumu- 
lated between his teeth and the cheek. 

If, however, in consequence of being situated so far back in 
the mouth that the eye fails to detect the condition of the part, 
he can complete his examination with his hands. With due prac- 
tice in this mode of investigation, one may become sufficiently 
expert in the manipulation of the mouth to dispense entirely with 
the aid of the speculum ; though of course there will be cases 
when in order to establish a thorough diagnosis of the exact and 
positive condition of the part, this instrument cannot be dispensed 
with. There are also conditions where the examination cannot 
be carried out in the standing position, even with the assistance 
of means of restraint, and the animal must be thrown down, and 
even, says Bouley, " placed under the eflects of ether. In this condi- 
tion, the jaws are readily kept open and immobile, the tongue is free 
from contraction, and the hands and fingers can be carried over 
the entire length of the dental arches without the slighest danger 
to the operator." 

Manual exploration removes all doubt about the diagnosis, 
since the surgeon may, by skillfully practicing the taxis, recognize 
all the irregularities present, whether the vicious direction of the 
dental surfaces, the uneven wearing of the teeth, the cavities 
which may exist in their thickness, or the condition of their im- 
plantation with that of the alveolar cavity, etc. 

When the mucous membrane has been excoriated by the sharp 
projections of the teeth, when the gums are highly inflamed, and 
the jawbones have been bruised, and are necrosed and suppurating; 



332 OPERATIONS ON THE DIGESTIVE APPARATUS. 

when tlie saliva which flows from the mouth is abundant, gluey 
and foetid in odor ; when the mouth is hot, the mucous membrane 
injected, and in the regions where this di£fused inflammation has 
started, lesions are apparent corresponding to the cause that pro- 
duced them, such as deep cuts on the internal face of the cheeks, 
which have been torn by the asperities of the teeth ; when there is 
swelling and redness of the gum at the point where it is inflamed ; 
when there is enlargement of the bone, with a grayish hue at the 
point where it is exposed and in process of sloughing ; or again if 
these fistulas penetrating the spongy tissues of the maxillary bone 
— all this becomes evident under the careful and accurate manip- 
ulation of the instructed fingers. 

Besides the exhibition of the general symptoms belonging to 
all diseases of the dental apjoaratus, caries of these organs is 
characterized by some special characters belonging to them ex- 
clusively. Principal among these is the peculiar foetor of the in- 
terior of the mouth and of the saHva flowing from it, which is 
sui generis. There is also the escape from the mouth of this 
saliva in excessive quantity and in long, slobbering masses. Then 
there is the existence on one of the faces of the carious tooth, and 
principally on the crown, of a blackish spot, or of a hole, or of a 
large excavation, penetrating the substance of the tooth at a vary- 
ing depth, according to the extent of the disease and the duration 
of its existence — the violent pain experienced by the animal when 
the percussion is applied on the tooth, or its cavity explored with 
the instrument — the swollen condition of the gum surrounding the 
diseased tooth ; its red color ; its want of adherence in some places, 
and the hemorrhage with the oozing of pus when pressure is ap- 
pHed directly over those same places; the soiled appearance of 
the dental surfaces on the side of the diseased tooth, caused by 
particles of food remaining adherent to their anfractuosities, and 
filling up the cavity of the carious tooth, or forcing themselves 
between the tooth and the gum, and spreading, diffusing the most 
repulsive odor — these all belong to a carious condition of one or 
more of the teeth. But if in addition to this the caries is of long 
standing, and has advanced towards the root of the tooth, the or- 
dinary complications pertaining to its development in the maxil- 
lary bone at the alveola take place, and that point becomes the 
seat of an inflammatory swelling, manifested externally by a pain- 
ful enlargement, hot and oedematous, which gradually increases, 



OPERATIONS ON THE TEETH. 333 

though at a given time it may remain stationary, hard and resist- 
ing. Again, as the progress of the disease continues, the hy^jer- 
trophied dental root, by its continued pressure outward, may 
destroy the external surface of the bone, and form a communica- 
tion between the bottom of the diseased alveola and the external 
plate of the maxillary. In these cases pus, saliva and putrefied 
food collect or filtrate into the subcutaneous cellular tissue, and an 
abscess is formed which soon ulcerates and empties itself on the 
surface of the cheek. Once open, this abscess has no tendency 
to heal, but, on the contrary, maintains its fistulous form, and dis- 
charges through its opening a mixture of pus, saliva and food, 
having the very repulsive and characteristic odor already men- 
tioned. Exploration of this fistula with the probe will give different 
results according as the fistulous tract is straight or irregular. 
In the first instance, the probe will penetrate directly into the 
mouth, opening on one of the faces of the diseased tooth, or even 
passing into the center of its carious crown; while in the other 
case it is arrested by the spongy substance of the ulcerated max- 
illary; or it may strike against the root of the diseased molar. 

At this point, changes will have taken place in the mouth, 
upon the svirface of the teeth, on the side of the jaw where the 
disease exists. These changes vary, and consist either in a great 
obhqmty of the tables of the teeth, the crowns or rubbing sur- 
faces being beveled in very obUque and opposite directions, or in 
the well marked elevation or projection of the molars correspond- 
ing to the diseased grinders, in the healthy jaw; a projection 
which is in proportion to the diminished size of the opposite 
carious tooth which stands much lower. The first condition is 
observed when the pain caused by the caries has entirely prevent- 
ed mastication on the diseased side, and the second, when, not- 
withstanding the caries, the performance of mastication has still 
contiaued. 

The condition then presented by the carious tooth may also 
vary. In some cases it may still be complete in its alveolar con- 
nection, though otherwise partly destroyed, and yet firmly ad- 
herent by its root. In others it may be broken, entirely or in 
fragments, merely parts of the outer surface being present; 
while again, some broken fragments, more or less detached, may 
remain in the alveolar cavities. 

Caries of the first and second superior molars may become 



334 OPEEATIONS ON THE DIGESTIVE APPARATUS. 

complicated with lesions of the nasal cavities, when the ulcerating 
process has been followed by a perforation between one or other 
of these cavities and the mouth. This lesion is accompanied by a 
discharge taking place on the side of the nose corresponding to 
that of the diseased tooth. This discharge is of a muco- purulent 
character, and mixed with saliva and food, which gives it the 
usual foetid odor as weU as a peculiar green appearance. It is 
very different from that belonging to glanders, and is too charac- 
teristic to justify by its presence an error in diagnosis in that 
direction. If, however, the same compUcations take place in the 
molars, whose roots rest on the sinuses of the head, the symp- 
toms which are manifested are often so nearly similar in aspect 
to those of chronic glanders, that the commission of an error 
should not be considered whoUy inexcusable. Careful examina- 
tion win readily bring out the differential diagnosis between the 
two diseases, though so different in their ensernble. "When the 
caries of one of these last molars exists to such an extent as to 
transform the mucous membrane of the sinuses into a sup- 
purative surface, and to cause the development of granulations 
upon its surface ; or to allow the collection of pus in the cavity of 
the sinuses, a discharge becomes estabHshed through the nostril 
of the side of the diseased tooth and affected sinus. This dis- 
charge is white, grumous, very abundant, and keeps increasing, 
and has also an extremely foetid odor, identical with that of dental 
caries. 

The lymphatic glands of the maxUlary space then become 
swollen, hard, though painless, and loose under the fingers. The 
plates of the zygomatic, of the superior maxillary and of the 
nasal become swollen, and give a dull sound on percussion. 
Sometimes their surfaces are so thinned out that it flexes under 
the pressure of the fingers, and they are then surrounded by an 
oedematous infiltration of subcutaneous cellular tissue. 

The long and minute consideration which we have thus given to 
the diseases of the dental apparatus has been principally devoted 
to the molar teeth of herbivorous animals, although many of the 
conditions observed in the grinders may also be found belonging 
to the incisors. Indeed, incisor arches may also offer abnormali- 
ties in the number of teeth, in their position, and in the direction 
or the length of these organs, and they may also become the seat 
of accidental lesions, such as fractures, luxations, or the too 



OPEBATIONS ON THE TEETH. 335 

rapid wearing of various parts of their surfaces, though it seldom 
reaches the point of caries. 

The different indications which the majority of these patho- 
logical conditions may impose resemble so nearly those required 
under similar circumstances for the grinders, that it becomes un- 
necessary to appropriate a special chapter to their discussion, and 
we therefore proceed to the consideration of the general opera- 
tions performed upon the teeth, according to the indications 
which may be from time to time presented. 

Opekative Dental Stjkgeey. 

Two principal indications present themselves under this head- 
ing. J^irst, the leveling of the frictional dental surfaces, for the 
removal of any existing asperities or sharp projections, in order 
to establish a perfect coaptation, as weU as the free movement 
necessary for the execution of their function of attrition. Second, 
the extract 1071 of the teeth which have undergone such important 
alterations in their structure, that their conservation becomes in- 
compatible with the regular execution of mastication, or because 
of the serious compHcations they may involve. 

Leveling of the Dental Arches — The original mode of operat- 
ing to level the molar teeth consisted in making the animal chew 
on the blacksmith's rasp. It is a simj)le process, easy to jjerform, 
without danger to the animal, and so well answering the purpose 
that even to-day the process is still in extensive use. But this 
modus o^yerandi is not without its inconveniences, among other 
objectionable points, requiring to be repeated for several days 
until perhaps the teeth have become smooth by rubbing against 
the rough surface of the rasp — a result not always as satisfactory 
as it might be. More appropriate instruments have therefore 
been invented, though, in point of fact, none of them are other 
than more or less modified rasps or files, as they are truly called. 
Their number and variety are to-day very great, and theii" quali- 
ties vary veiy much, according to the taste, the ideas, and often 
the dexterity of those who use them. Samples of these files are 
represented in Fig. 340, and according to their general construc- 
tion may be classified as rough and fine rasps, flat and angular, 
guarded, double and single on one or other of their edges. Some 
are simple, and formed of a single piece, while others are jointed 
and compound, and may be screwed or unscrewed with facility 



336 



OPERATIONS ON THE DIGESTIVE APPAKATUS. 




Fig. 340.— Samples of Tooth Rasps. 

for use and transportation ; some have the rasp fixed to a solid 
handle, and again, the handle in others is moveable, and may be 
changed as indications may present themselves. Their number 
in this country is about incomputable, and while many which we 
find registered in the patent ofiice are of real value, many others 
have no reason for being beyond their maker's whim. As we 
have said, the advantages which any of them may possess depend 
more on special conditions than on the resvilt to be obtained, in 
the removal of the small, sharp edges of the external surface of 
the tooth, or its lateral faces, resulting from an excessive develop- 
ment in the enamel. 

Whatever may be the file which the veterinary dentist may see 
fit to use, the manipulations required in its handling will be in all 
cases the same. In referring to this, the first question which 
offers is, whether the use of the speculum is necessary to enable 
the surgeon to file a horse's teeth? There is no doubt that in 
many instances it will be difficult, and even perhaps impossible, 
to compel the patient to keep his mouth sufficiently open to per- 
mit the use of the rasp with the necessary delicacy and freedom, or 
prevent him from constantly biting it, or keeping his jaws closed 
during the operation. In every instance, the play of the instru- 
ment will be sure to be interfered with by the excited patient. 

We believe that American practitioners were the first to dis- 
pense with the speculum in these cases ; and that to Mr. House, 
a celebrated veterinary dentist, who died not many years ago, is 
due, in fact, the paternity of this specialty in veterinary surgery. 

Whether the mouth of the animal is held open with a sjdccu- 



OPEKATIONS ON THE TEETH. 337 

lum, and the tongue drawn out and held on one side by an assist- 
ant, or whether the operator himself controls the tongue with one 
hand while working the instrument with the other, the manipula- 
tions must be the same, viz. : the passage to and fro of the file over 
the siu-faces requuing to be corrected, wherever they are rough 
and sharp ; filing them just as the smith files the iron he is shap- 
ing as he holds it in the vise. We beheve, however, that the 
rasping out ought to be done slowly, softly and without giving the 
animal any cause for fright or excitement. The method sometimes 
practiced of using the rasp with a succession of rapid movements 
over the dental arches is certainly dangerous and hable to be ac- 
companied with accident to the patient. An ii-ritable, struggling 
animal, by violent movements of the head, or in his attempts to 
chew on the rasp, may easUy receive injuries from the rough con- 
tact of the instrument with the delicate structures of the mouth. 
After such a passage of the rasp a number of times over the teeth, 
the hand introduced in the mouth will at once detect the effect 
upon the patient. 

Although the use of the speculum may be advantageous in 
many instances, there is certainly a risk attending its use, in the 
possibility of bruises and lacerations which may occiu- at the bars 
when the animal, annoyed by its ajDpHcation, chews upon it in his 
endeavors to close his mouth. 

The work of filing when the teeth are sharp is of common in- 
dication, and finds its direct appHcation under the special condi- 
tion that the edges or asperities which are treated should not be 
too large or too prominent. If this should be the case, and the 
inefficiency of the file or rasp, however, become evident in the trial, 
other means remain for accomplishing the desired pm-pose. Such 
a contingency was not lost sight of in former years, and chisels 
and gouges were then emplojised to reduce the excessively devel- 
oped projections of enamel. 

With these instruments the patient was either thrown or treat- 
ed on his feet, his mouth being opened with a speculum, with his 
tongue drawn out and held on one side. The chisel was then laid 
against the dental projection, and an assistant striking it with a 
hammer, the excess of tooth was knocked oi9f. Bouley considered 
this mode of operation dangerous. " The chisel might, under the 
imjDulse received by the hammer, slide in the mouth and severely 
injure the tongue, the cheeks, and the soft or the hard palate ; or 



338 OPERATIONS ON THE DIGESTIVE APPARATUS. 

in animals advanced in age, the tooth, might be fractured or dis- 
located; or again, the operator himself might be injured by the 
instrument, vrhen, suddenly displaced by a movement of the ani- 
mal, the assistant knocks against it." 

It was to remedy this objection that Brogniez invented his 
odontritor (Fig. 341), an instrument which carries on one end a 
blade sharpened on both edges, and on the other is hollowed out, 
in order to allow the play of a rod through one-half of the length 
of the instrument. This rod is provided with a transversal handle, 
which also acts as a hammer, by which the blow is carried against 
the sharp edges of the tooth. 

When the odontritor is used, it is not necessary to use a spec- 
ulum to open the mouth, the holding of the tongue out of the 
mouth being sufficient. The operator, holding the instrument 
with the left hand, places the anterior sharp edge against the j)ro- 
jecting portion of the tooth, and holding the rod by the handle 
full in his right hand, moves it to and fro, striking at the proper 
points as he moves it. This operation is repeated on both jaws 
until all the sharper edges of the teeth have been cut off, and is 
completed by passing the rasp over the dental plates, as is done 
when the teeth are not too sharp. 

Several modifications have been made in the conformation of 
the odontritor, but that of Prang d is probably the best (Fig. 342) 
It consists in having three blades, which may be changed at will 
and which vary in the form and disposition of their cutting edges. 
This instrument is considered superior to that of Brogniez, and 
is thought to work to better advantage when the elevation of the 
tooth is well marked. 

The odontritor answers perfectly for leveling the molars when 
the projections are not excessively developed, or do not offer too 
great resistance to the action of the blade. But when an entire 
tooth projects above the general level, the odontritor ceases to be 
of any advantage, and it becomes necessary to perform the resec- 
tion of the tooth, consisting in the removal of all that portion of 
it which rises above the level of the general dental surface. 

To Brogniez is due again the first instrument invented for the 
performance of this operation in the chisel odontritor (Fig. 343). 
This is composed of two rods, one of them having at one end, like 
the ordinary odontritor, a frame of sufficient dimensions to allow 
the entire molar to pass through it, and on the anterior border of 



OPEEATIONS ON THE TEETH. 



339 





Fig. 341.— Brognlez'B Odontritor. 



Fig. 342.— Prang6's Odontritor. 



340 



OPERATIONS ON THE DIGESTIVE APPARATUS. 



this frame a solid blade with a sharp con- 
cave edge tvirned backward. The other 
extremity of this rod carries a transverse 
prolongation, which serves to change the 
y j position of the blade when necessary, and 
which has on its shorter portion a hole 
through which the other rod is allowed 
to slide. This second rod has on one end 
a sharp blade which slides into suitable 
grooves made in the frame of the first, 
and is curved forward on its front edge. 
On the other extremity it carries a metal- 
lic mass which is used as a hammer. 

In using this instrument, the tooth 
being enclosed in the frame between the 
two blades, the movable rod, with its sharp 
edge, is pushed against the blade of the 
frame, and a strong blow of the hammer 
cuts off the tooth smoothly and evenly. 

The chisel invented by Gowing (Fig. 
344), works somewhat on the same princi- 
ple as that of Brogniez. 

Resection of the teeth has also been per- 
formed with the instruments used for the 
same operation on bones. Saws of various 
form and design are also recommended, 
the chain saw, which we have often used, 
beinff one of these. But there are serious Fig-344— Gow- 

<=• ing's Chisel. 

objections to this latter mstrument, among 
which is its liability to become heated while in use, 
when it becomes unable to " bite " upon the hard 
dental substance, and may, moreover, break or slide. 
The only method of overcoming these 
objections, which, in fact, may occur 
in using any kind of saw, is by hold- 
ing a wet sponge against the tooth to 
which the instrument is applied — a 
precaution which is not always of easy 
adoption, and which can scarcely be 
effected without more or less danger 
of wovmding the hand which holds 

Pig. 343.— Brogniez's Tooth Chisel. 



OPEKATIOKS ON THE TEETH. 

Fig. 3J5. 



341 




Liautard's 
Cutter. 



Scheffler-8 Extractor and Molar Cutter. 



342 OPERATIONS ON THE DIGESTIVE APPARATUS. 




Fig. 345a.— Hamlin's Molar Cutter. 

the sponge. But when none of these modes of operation can be 
readily applied, the use of the tooth-chisel becomes the order. 
Its application is simple, and with a weU-made instrument in the 
hands of an expert operator, quick and strong, the resection can 
be readily performed. 

The array of tooth-chisels or resectors is beyond compute in 
variety and number, and especially in this coimtry where the in- 
stinct of mechanical invention is so universal, and the specialty of 
veterinary dentistry is so extensively practiced, and many different 
kinds can be inspected among the samples of workmanship which 
decorate the show-cases of our instrument makers. Among the 
principal forms, we may, however, mention those which recall the 
names of Lafosse, Moller, Scheffers, Gowing in Europe, and of 
Clarke, House, Liautard and Hamlin in this country (Figs. 345, 
345a). Some of these instruments have their jaws closed, others 
have them open. Some work by a peculiar thread-screw arrange- 
ment, others by the manual power of the operators ; and again, 
the blades of some are straight and others curved, and still others 
are sharp like a concave saw. In theii- ajDplication they all work 
upon about the same principle, and are used in the same man- 
ner. The mouth being opened, the tooth is seized between the 
jaws of the forceps, and by the pressure of the screw with 
which some of them are armed, or by the unaided strength of the 
operator, the tooth is squeezed and cut off with a sudden snap, 
followed by the dropping out of the mouth of the amputated 
portion. As a rule, the surface left on the tooth shows but a 
slight roughness, which can be smoothed off with the rasp. 



OPERATIONS ON THE TEETH. 



343 



Extraction of Teeth. 

The extraction or removal of teeth is indicated for the reduc- 
tion of any excess in their number, which may interfere with mas- 
tication ; or when these organs are abnormal in form or direction, 
and obstruct the growth or usurp the place of a permanent tooth ; 
or when they are diseased with caries, or affected with any of the 
pathological conditions which we have before considered ; or when 
they become the cause of a dental fistula. 

To extract the incisors of any of our domestic animals, the 
molars of dogs, or the caduc molars of large herbivorous animals, 
some of the various forms of tooth forceps that are used in human 




Fig. 346.— Samples of Tooth Forceps. 

dentistry or the different shapes of the key of Garangeot or special 
larger forceps, such as that of Lecellier (Fig. 848) or the enlarged 
Garangeot's key, as modified by Delamarre (Fig. 349), wall be 
necessary. The modus operandi is generally simple ; the tooth, 
still firmly attached to its alveola, or perhaps loose and more or 



zu 



OPERATIONS ON THE DIGESTIVE APPARATUS. 
1 




Fig. 347.— Garangeot's Keys. 

less pushed out of its place by a succeeding growth, is seized be- 
tween the jaws of the forceps, or of the Garangeot's keys, and is 
easily wrenched from its position by a strong pull or with a sHght 
twisting motion sufficient to lacerate its last adhesions. 

The extraction of the permanent molars of a horse is a diffi- 
cult and, under some circumstances, a serious operation. Their 
mode of implantation and insertion in the alveolar cavities ; the 
great length of their roots as compared to the small dimensions 
of their free portion; the narrow connections which exist be- 
tween them, and withal, the solidity of the dental arch — aU these 
conditions are sufficient to explain the serious character of the 
prognosis of this operation, and the difficulties which are often 
encountered when the organ to be removed is the molar tooth of 
a horse. These difficulties, however, vary considerably under pe- 
culiar conditions, such, according to Peuch & Toussaint, as " the 
age of the subject, the position of the tooth on one or the other 
jaw, and the degree of alteration of the tooth to extract." 

For example, the operation is more difficult in young animals 
than in adult, or older subjects, the latter requiring less effort, 
the root of the tooth being shorter and the adhesion to the alveola 
less solid. The upper are less firmly attached than the lower 



OPERATIONS ON THE TEETH. 



345 







Fig. 348.— Lecellier's Tooth Forceps 
for Molar. 



Fig. 349.— Garangpot's Keys, Modi- 
fied by Delaiuarre. 



molars, the presence of the cavities of the sinuses, and the 
diminished thickness of the walls of their alveola rendering their 



346 



OPERATIONS ON THE DIGESTIVE APPARATUS. 



insertion and implantation less tenacious than in the lower. The 
extraction of the front is less difficult than that of the posterior 
molars. At times, as when the teeth are partly destroyed by 

caries, a single effort wiU be suffi- 
cient to extract them ; but in other 
cases, as when the periosteum is dis- 
eased, and the roots adhere more 
intimately to the alveola, the extrac- 
tion becomes very difficult. And 
again, if the tooth having a hyper- 
trophied root, resists the action of 
the instruments through the op- 
position of those immediately sur- 
rounding it, which, though healthy, 
are less firmly fixed in their alveola, 
which are mechanically dilated by 
the outward pressure made upon 
the plates of the maxillary bone, is 
easy to loosen and dislocate them ; 
and this is a circumstance which 
must not be overlooked during the 
manipulation required for the ex- 
traction, in order to avoid serious 
disturbances of the dental appa- 
ratus. 

In the extraction of a molar, the 
patient must be thrown, and the 
head well elevated, the mouth being 
kept well open by means of a per- 
fectly safe speculum, such as that of 
Lecellier (Fig. 350), but we think 
it rather clumsy to handle. Bouley 
recommends the etherization of the 
patient. The mouth is to be thor- 
oughly cleansed. There are circum- 
stances, however, in which the op- 
eration of casting is unnecessary, 
and, in fact, our own personal ex- 
perience has raised doubts in our 
PIG. 350.-Spectiium of Lecellier. mind as to the necessity at any 




OPERATIONS ON THE TEETH. 



347 





Fig. 351.-PIas8e Molar Extractor (full view). Fig. 353. _- 



The same (side view). 



348 OPEKATIONS ON THE DIGESTIVE APPARATUS. 

time of exposing the animal to the possible accidents which may- 
attend this mode of restraint. We hold strongly to the expedi- 
ency of performing the operation in the standing position. There 
will necessarily be cases in which to attempt to remove a tooth 
with the animal standing would be simple folly and time lost, but 
with many operators in this country, we have in several instances 
succeeded in extracting a condemned molar without any other 
means of restraint than a twitch on the patient's lower lip or on 
his ear. The removal of molars is effected in two ways — ^by pul- 
ling, or by repulsion or gouging out. 

The method by extraction or evulsion, is preferable whenever 
it is practicable, having the advantage of causing less injury to 
the surrounding structures, and is objectionable, princij)ally for 
the posterior teeth, which always oppose great difficulties to the 
operation. The oldest instrument used in this operation is the 
enlarged key of Garangeot, as modified by Delamarre. lis ajDpli- 
cation has always seemed to us difficult, if not dangerous, and we 
think that it involves more or less risk of fracture of the plates of 
the maxillary bone, on which account we prefar the large tooth 
forceps, which may be found under many forms and designs. The 
forceps of Plasse (Fig. 351), of Wendenburg (Fig. 353), of Pill- 
wax (Fig. 354), of Gowing (Fig. 355), of the same inventor, as 
modified by Bouley (Fig. 356), those of Gunther (Fig. 358), the 
key-forceps of Bouley (Fig. 357), those of House, of Walters, and 
many others will furnish the operator a large collection from which 
to select. Many of these instruments are very complicated (as that 
of Scheffer) ; some are clumsy and difficult to handle ; have levers, 
like those of Wendenburg and Pillwax; many work by merely 
grasping the tooth and holding it by a peculiar arrangement of 
spring, or of thread-screw, and thus to the end of the chapter. 

We have for many years given the preference to the simple 
forceps of Gowing, leaving off the little rod which is connected 
with the cross-piece which carries the thread, and which is to be 
screwed on the handles of the instrument to hold them firmly to- 
gether. What we think most essential in the instrument is that 
its arms should be firm and so solid as not to bend or yield when 
the screw is applied on them, and that the jaws of the forceps 
should not be too narrow nor too curved, and above all, that the 
instrument should not be made unnecessarily heavy, a fault which 
we have too often observed in some of the continental patterns. 



OPEKATIONS ON THE TEETH. 



349 



(D 



Fig 353.— Wendenburg 
Forceps. 



Fig. 354.— Pillwax'a 
Forceps. 



Fig. 355.— Gowing's 
ForeepB. 



Besides the forceps which we have named there are many 
others, but whatever may be their plan or shape, the manner of 
using them includes nearly the same manipulations for all. These, 
in their various steps, are done about as follows : the animal be- 
ing properly secured, with his mouth open, and his tongue drawn 



350 OPEEATIONS ON THR DIGESTIVE APPARATUS. 




Fig. 356.— Gowing'ti Forceps, Modified by Bouley. 

out on one side, an assistant inserts the forceps into the mouth, 
adjusting it to the tooth to be extracted, and notifies the op- 
erator of the moment when he can close the jaws of the instru- 
ment together, which is done in various ways according to the 
kind of instrument in use. When the tooth is properly seized 
and firmly held by the forceps, the operator, using all his force, 
carefully and slowly oscillates the instrument from left to right, 
and from right to left, in order to produce the gradual dislocation 
of the organ, and when it is loosened from its attachments it is 
drawn vertically out of its canity by a final movement of evulsion. 
There are instruments possessing a lever attachment close to the 



OPERATIONS ON THE TEETH. 



351 




Fig. 357.— Bouley's Tooth Keys. 

jaws by which the extraction of the tooth is considerably facilitat- 
ed. If the animal has not been put tinder general anesthesia the 
dislocation of the tooth is very painful, and often accompanied by 



352 



OPEEATIONS ON THE DIGESTIVE APPARATUS. 
A B C 




Fig. 358.— Guather'8 Forceps. 



violent struggles, at the critical moment; and if the tooth is not 
very strongly held by the forceps, it is possible that it may shp 
out of the jaws of the instrument and di'op into the mouth. To 
avoid the possibihty of its passing into the phaiynx, we think it 
would be but a prudential measure to have an assistant keep his 
hand in the animal's mouth ready to secure the tooth, if necessary, 
before it passes beyond the soft palate. 



OPEEATIONS ON THE TEETH. 353 

The second mode of extracting molars, or that by repulsion or 
gouging, is the only one possible under aU. the circvimstances, 
when the prehension of a carious or diseased tooth cannot be 
effected by the instrument used in the first method, as, for in- 
stance, in cases of disease of the posterior molars when the carious 
tooth is so far diseased or destroyed that not enough of its sub- 
stance remains above the root to be reached by the forceps ; or 
again, when the exostosis of the root has reached such dimensions 
that it will not aUow its exit from the alveolar cavity, whatsoever 
efforts may be made to overcome its resistance. 

This operation was first recommended by H. d'Arboval, and 
although it has been condemmed by some practitioners, is certainly 
indicated for all operations upon the molars. All the superior 
molars, together with the three anterior inferiors, are readily 
reached by their roots, in trephining the external plate of the 
bones in which they are implanted. The posterior inferiors are 
the only ones that present any serious objections, and the trouble 
is truly a tangible one, being nothing less than the necessity of 
passing through the entire thickness of the masseter muscle. 

The tooth demanding removal being surely identified, and the 
impossibility of removing it by the mouth well estabhshed, the 
animal is thrown on the side opposite to that which is occupied 
by the diseased organ, and placed under complete anesthesia. 
The location of the alveolar walls, upon which the operation is to 
be made in order to reach the root of the tooth, must be first well 
determined. If it is one of the last three upper molars, it will corres- 
pond to the sinuses. But the operator must not allow himself to 
be deceived by the presence of a fistulous opening, which, by ap- 
pearing on the surface of the skin to indicate the point of attack, 
may in fact mislead him by conducting him to a point consider- 
ably remote from the diseased tooth. A positive and satisfactory 
diagnosis being settled, and the hair being clipped, a large V or 
cross-shaped incision is made over the spot selected for the tre- 
phine, and carefully avoiding the infliction of any injury to the 
muscles of the region, the sinuses are opened by removing two 
or three circular portions, at a tangent to each other, to effect the 
removal of a fair-sized piece of the bone. The edges or prolonga- 
tions which remain are levelled off with the bone forceps, which 
is certainly preferable to any other means ; or if the opening made 
in the bone is too small, it can also be enlarged by using the same 



354 OPERATIONS ON THE DIGESTIVE APPAEATUS. 

bone forceps, by nipping o& fragments from the edges and making 
entrance into the sinuses of the proper dimensions. The wound 
and the sinuses are then thoroughly cleaned out, and the blood 
and the pultaceous purulent collection found in their bottom 
thoroughly removed. This exposes the root of the tooth, in the 
form of a hard, dry, greyish mass, analagous to a piece of necrosed 
bone. The operator, then holding the blunt gouge, or rejyoussoir 
in his left hand, apphes it through the sinuses against the middle 
of the dental root, and with a strong mallet held in his right, 
strikes upon it with firm and steady blows. The mouth of the 
animal being held open by the speculum, an assistant with his 
hand upon the crown of the tooth studies the effect of each blow, 
and notes as it yields to the percussion, and moves and loosens until 
it becomes detached, and faUs, liberated into his hand, secured 
by his continuous grasp from any possible danger of being swal- 
lowed. As a rule the tooth is pushed out of its cavity by the first 
blows, either entire or in as many portions as it may have been 
divided into by the carious process. But at times it becomes 
necessary to repeat the percussion and to use considerable force 
to compel it to leave the jaw. 

The modus operandi is about the same for any of the molars, 
though for the lower teeth greater force in the blows of the mal- 
let is generally required, in consequence of the greater thickness 
of the walls of the alveolar cavities in the lower maxillary bone. 
If it is one of the posterior lower molars which is the subject of 
the operation, the masseter muscle must be cut through, but the 
general manipulations are otherwise the same, care being required, 
however, to avoid injury to the glosso-facial artery, or the duct of 
Steno, 

Though apparently a severe operation, this is not a dangerous 
one, the wounds which it involves healing rapidly, and the great 
advantages which are realized by it, among which may be included 
the cleansing of the sinuses, and the removal of their suppurative 
collection, which could not be otherwise secured, amply compen- 
sating for the severity of the process. 

After the operation the wound is, of course, to be thoroughly 
cleansed, fragments of bone to be removed, and acidulated gargles 
used to wash the mouth and the cavity of the alveola of its blood. 

The cicatrization of the external wound generally gives no 
trouble to the surgeon, and requires no particular methods be- 



OPERATIONS ON THE TEETH. 355 

yond those of ordinary cleanliness and proper attention to the 
granulating process. It is the cicatrization of the internal wound 
which requii'es attention, and in some cases a great deal of it. 
This is in order to guard against the collecting and the packing of 
the food in the cavity of the alveola, and thus interfering with its 
closing up by proper granulations. The diet of animals thus 
operated on must, of course, consist almost entirely of liquid food, 
as mashes of bran or of oatmeal ; hay teas, flour water, milk, etc., 
or of cooked roots, scalded grains and the like. According to 
some authors, fibrinous food is dangerous only diuing the early 
days immediately following the operation, but our experience has 
taught us that neither solid nor semi-solid food is to be allowed 
to an animal which has lost a molar tooth, for a period of from 
three to four weeks, and during that time the alveolai' cavity ought 
to be thoroughly cleansed out after every meal, until all possibility 
of danger has subsided. 

The vacuum left in the dental arch after the removal of a tooth 
is never entirely filled up, but it gradually diminishes, in conse- 
quence of the oblique direction which the teeth in front and behind 
are disposed to assume, and which, though it brings them closer 
to each other, never brings them into actual contact. It may hap- 
pen that by reason of this vacant space the tooth on the opposite 
side of the jaw may acquire a tendency to grow to excess, and from 
want of wear, ultimately project above the level of the other teeth. 
In reference to this it will be but prudent to watch the condition 
of that particular tooth, and to be prepared to reduce it to its 
proper level, if that should become necessary. 

In reference to accidents that may occur during operations 
upon the teeth, we have already mentioned the jjossibihty of deg- 
lutition of the tooth as it is drawn from its socket. In some cases 
reported by Kenault and Bouley fatal results have followed, caused 
by violent colics thus induced. Strong cathartics have been rec- 
ommended in these cases for the removal of the foreign body, but 
the precaution which we have already mentioned will effectually 
prevent the possibiHty of this accident. Bruises and excoriations 
of the bars, with the speculum, and hemorrhage, are accidents 
which also sometimes accompany these operations of extraction. 
The first is not usually a matter of any importance, unless necro- 
sis of the jaw should follow ; and as for the hemorrhage, unless it 
results from direct injury to the palatine artery, it is easily con- 



356 OPERATIONS ON THE DIGESTIVE APPABATUS. 

trolled by pressure and packiiig with oakum or compressed 
sponges. Fractures of tlie alveola, or of the lower maxillary 
bone, are of a more serious character than any of the preceding 
injuries, the last, mentioned iu a case recorded by Koerter, having 
necessitated the destruction of the animal. 

Filing Teeth. 
This operation has not, we beUeve, as yet entered into the 
general practice of veterinary surgery, and, with the exception of a 
few veterinarians on this continent who have attempted it, we think 
that in the presence of the many difficulties which exist in reahz- 
ing a perfect result, similar to those obtained with the thorough 
work of human dentistry, it will be some time before this branch 
of veterinary dentistry can be practiced with any great prospect of 
good and permanent results. Our experience in fiUng the teeth 
of our domestic animals is very Hmited, and on that account we 
will refrain from saying more about it, referring our readers to 
the work of Dr. Hinebauch on "Veterinary Dental Surgery," 
where the subject is treated rather extensively. 

Canine Dentistry. 

Operations on the teeth of the dog are sometimes indicated 
under some peculiar and abnormal conditions, such as irregu- 
larity in number or in direction, or in cases of traumatism, such 
as fractui-es or dislocations. Their extraction is performed ynth. 
tooth forceps, as we have already had occasion to remark. Their 
resection has been recommended by a French veterinarian, Mr. 
Bourrel, as a means of preventing rabid inoculation (Fig. 359). 
The operation is a very simple one, and consists in smoothing 
over the sharp points of the teeth with a file, though sometimes 
sharp nippers are used in preference. 

But an operation which is of daily necessity is that of clean- 
ing the teeth by removal of the accumulation of cement or tartar, 
which gathers on the external surface of the tooth, at its insertion 
in the alveolar cavity, where it forms a thick crust, of greenish 
gray color, composed of microscopic fungi. In neglected cases, 
the gums become irritated and ulcerated, and the tooth, partially 
denuded of its gum, exposes not only its free portion, but por- 
tions of the root also, sometimes even becoming loose and drop- 
ping out of the jaw. There is in these cases a free and abundant 



OPERATIONS ON THE TEETH. 

a 



357 




Fig. 359.— Bourrel's Mode of Piling Dog's Teeth. 



flow of saliva, of a characteristic and putrid smell ; mastication 
becomes impossible, and the animal becomes a regular martyr to 
the lack of attention of his dental apparatus. The formation of 
these concretions can be prevented in animals in the same way and 
with the same care that is exercised in respect to the human when 
teeth- washing, brushing, etc., with some of the properly com- 
pounded tooth powders, will remove a slight coat of the offensive 
deposit, but if the accumulation is quite large, it must be scraped 
off with proper instruments (Fig. 360), carefully avoiding, if prac- 
ticable, any injury to the gums, or the loosening of the teeth. 




Fig. 360.— Tooth Scrapers. 



X 



358 OPEKATIONS ON THE DIGESTIVE APPARATUS. 

If several teeth are loose, and their loss is threatened, the bet- 
ter course in regard to their extraction wiH be to remove them 
singly, and not all at the same time, lest a serious hemorrhage 
might supervene, which might even endanger the animal's hfe. 

OPERATIONS ON THE TONGUE. 

The pathological lesions to which this member of the digestive 
apparatus is subject, and which may require surgical interference, 
are princij^ally wounds and tumors, the former demanding either 
sutures or amputations of the organ, partial or complete. The 
latter, however, present a greater variety of indications, according 
to the nature of the neoplasm with which the organ may be af- 
fected. Wounds of the tongue are quite frequent, but the most 
common are probably those of the lacerated kind, though again, 
they may be the result of contusion, incision, or may even be caused 
by burns. 

Produced generally by self-inflicted bites, caused by falling, 
or during epileptic seizures, they are usually made by the incisors. 
A badly made bit, or a halter or rope tightly binding the mouth 
and pressing down the tongue, may also produce a bruise, or even 
a complete laceration of the organ. They are also not uncom- 
monly seen as the result of bites inflicted by one animal upon an- 
other, placed in an adjoining stall, when the separation between 
them has been insufficient. In these cases, not only a portion of 
the tongue, but often also the fraenum may be more or less lacer- 
ated — a condition which may also take place when the tongue 
has been pulled out by an assistant, a groom or other person, and 
the horse rebelling, pulls back violently and suddenly. Against 
such opposite forces the soft structure of the frsenum readily 
gives away. The burnt wound, or scalding of the tongue, may 
arise from the administration of a drench not sufficiently cooled, or 
of too irritating a nature. The common way of steaming horses 
with bran heated with boiling water, is also an occasional cause. 

Injuries such as these are generally easily detected, present- 
ing, as they do, a series of symptoms which may properly be 
called general. Difficulty in eating, and a more or less abun- 
dant flow of stringy saliva, which also may be mixed with blood, 
is apt to be among the signs. In relation to the special char- 
acters, noticeably, there may be in one case a protrusion of the 



OPERATIONS ON THE TONGUE. 359 

tongue out of the mouth, with perhaps a drawing of the organ to 
one side, or it may be pressed. between the incisors and hanging- 
more or less outside of the buccal cavity. In opening this 
cavity, the tongue may then be seen to be lacerated at its free 
portion, the laceration being transversal or longitudinal, complete 
or incomplete, and varying in dimensions, from a small portion of 
the organ nipped from the main body, to nearly the entii'e portion 
in front of the frsenum. If the anterior portion is missing, the 
frsenum may be seen in its normal condition, or again may be exten- 
sively torn, in. which case the tongue is commonly hanging out of 
the mouth. If the laceration is complete, the part in front of the 
cut may have dropped outside and fallen into the bedding of the 
animal, or of the one next to him, both stalls being more or less 
spattered with blood from the hemorrhage which has accom- 
panied the injury. 

In cases of burns, the tongue presents all the symptoms of 
glossitis, it is swollen, its epithelium readily peels off, the saliva- 
tion is abundant, and the mouth heated and sore. 

Considered from one point of view, the prognosis of lacerated 
wounds of the tongue is not serious, there being but few forms of 
that injury which are not more or less amenable to treatment. The 
nature of the prognosis varies, of course, with the extent of the 
wound, the depth of the tissue which it involves, and the amount 
of substance already lost or requiring removal. A complete 
section is always a serious matter, especially in herbivorous 
animals, by which the tongue is so largely employed, and so ef- 
ficient, as an instrument for the prehension of food, as well as for 
aiding in its mastication, by keeping it in contact with the grind- 
ers during the process of chewing. 

In carnivorous animals, as in dogs, we have seen the complete 
sloughing of the free portion attended with such difficidty in eat- 
ing, that the destruction of the patient became necessary in 
order to avert his death by starvation. 

In almost all conditions of laceration of the free portion of the 
tongue, there is an indication of an attempt to effect the union of 
the di%'ided parts, and our experience has led us to the conclusion 
that no one is justified in refusing to treat a wound of the tongue 
or abandoning such a case without at least an effort to save it, 
even, as in some cases, where the divided parts are held together 
by the smallest portion of substance. 



360 OPEKATIONS ON THE DIGESTIVE APPARATUS. 

SUTUEE. 

It is only by suture that the attempt can be successfully 
made. Peuch, Toussaint and Zundel advise the throwing of the 
horse, but we prefer the standing position for the operation. 
The instruments necessary are strong needles for metallic sutures, 
and soft, pHable lead wire. We prefer this kind of suture as being 
less liable to cut through the muscular structure of the organ 
and having less tendency to give way. Having carefully washed 
the surfaces of the lingual wound, we apply an inteirupted 
suture, varying the number of stitches, according to the extent of 
the laceration, and prefer the interrupted to the continued suture 
for the reason that if one stitch fails to hold, it can be easily re- 
placed by another. The important point is to secure a thorough 
hold for each stitch, or in other words, to involve a good portion 
of the tongue in the stitch on each edge of the wound. 

Wounds of the frsenum need no special treatment, but there is 
an indication which by its application greatly facilitates, though 

indirectly, the cicatrizing process of 
the two parts. It consists in placing 
the tongue in a muslin suspensory, 
having the shape of the free portion 
of the tongue, and sewed together 
on a part of their circumference, leav- 
ing an opening for the organ to enter. 
This suspensory is kept in place by 
two strings attached to the halter on 
Pig. 361.— Tongue Suspensory. each side of the cheeks. The use of 

this easily made appliance has given 
us great satisfaction, not only in keeping the tongue in the mouth, 
but also in hmiting the movements of the organ, and preventing 
the giving way of stitches. The suspensory is to be taken off 
two or three times a day, and washed, or changed for another, 
but niust be kept in place as long as this condition of the patient 
requires it. The mouth is to be kept clean by antiseptic astrin- 
gents and cooling gargles, by means of a syringe or an irrigator. 
The use of peroxide of hydrogen has given us excellent results in 
these cases. Nocard recommends the application of a muzzle 
upon the patient's nose, to prevent the prehension of fibrous 
food, keeping the mouth closed, and restricting the movements of 




OPERATIONS ON THE TONGUE. 361 

the jaws. Dui'ing the treatment the animal is to be fed with 
liquid or semi-Hquid food, as mashes and gruels of all kinds, with 
teas, milk, etc. It is only when the stitches are all united 
that the animal can be brought by degrees to its ordinary diet. 
After several days the sutures can be removed. 

Amputation, or Glossotomy. 

"When the sutures have failed, or when the peduncle which 
holds the divided portions of the tongue together is too small to 
permit the processes of circulation and nutrition to go on, the in- 
dications are to amputate the part of the tongue below it. This 
is done with the scissors ; the hemorrhage that may follow is sel- 
dom serious, and soon ceases spontaneously, or yields to the use 
of hemostatics. Sometimes, instead of direct amputation, or in 
order to avoid the hemorrhage, the removal of the divided portion 
is effected with an elastic hgatui'e — a mode of treatment also com- 
monly used for the removal of lingual tumors. The ecraseur has 
also been recommended, on account of the absence of hemorrhage 
attending its use. The animal whose tongue has been amj)utated 
eats slowly and with difficiilty. His prehension of liquids is also 
necessarily interfered with. It requires time and practice for 
him to acquire facility in performing the old functions with 
curtailed means. 

Adenotomy. 

This operation consists in the dissection and removal of such 
of the glands as are accessible and amenable to that method of 
treatment, including the lymphatic and sahvary, and is described 
as parotidian or maxillary, as one gland or the other becomes the 
subject of operation. The extirpation of these organs is indica- 
ted by pathological changes occurring in their structure, as in 
cases of chronic infiltration following a suppurative process, as 
seen in the lymphatic glands of the inter-maxillary space after 
strangles, and again when they become the seat of scirrous de- 
generation, or of melanotic deposits, or in cases of salivary fistula 
compHcated with loss of substance of the excretory ducts. 

Parotidian adenotomy is a very delicate operation, and has, 
therefore, been but seldom attempted. To Leblanc, in 1822, is 
due the record of its first performance, and of the advantages 
attending it. A reference to Figures 396 and 397, which show 



362 OPEKATIONS ON THE DIGESTIVE APPARATUS. 

both the superficial and the deep anatomical stnictm-es of that 
region, will at once suggest the difficulties to be encountered in 
the numerous and important blood vessels, which must be either 
avoided or ligatui-ed, and the important nerves which must be 
saved According to Brogniez, the operation is fully justified by 
its results, and jDossesses an undeniable claim to admission into 
the domain of authorized veterinary surgery. After Leblanc, it 
was performed by Brogniez, Vanhaelst, Delwart, Barlow and Per- 
civall. 

The Traite de Chirurgie Veterinaire furnishes the following 
description of the manual execution of parotid adenotomy : " The 
animal, being well prepared, is thrown, with the parotid region 
of the side on which he hes resting on a small bundle of straw, in 
order to render the gland, which is to be operated upon, more 
prominent, and the hair being clipped, a long incision is made in 
the direction of the organ, viz., from the anterior part of the base 
of the ear down to below the glosso-facial branch of the jugular vein. 
This first incision, it may be remarked, must be made more to the 
anterior border of the gland, which is strongly adherent to the 
maxillary bone, as well as to the blood vessels and nerves passing 
that jjoint, and, if necessary, a second incision can be made be- 
hind the first and perpendicular to its lower extremity. The skin 
being dissected from the whole extent of the gland, the beginning 
of the separation of the organ is made near the facial nerve, from 
thence gradually working downward. The lower extremity of the 
gland is isolated, and after it the posterior border, to terminate 
by the superior extremity, which surrounds the concha — in other 
words, without reference to the muscular layer that covers it, or 
to some little glandular masses which are isolated from the prin- 
cipal mass, nor even to its central portion situated under the fa- 
cial branch of the jugular vein ; the gland being thus separated 
is removed in its whole circumference. After ligating the blood 
vessels which may have been opened, the wound is dressed and 
closed with quill sutures. Suppuration is soon established, the 
granulations rapidly develop themselves, and the cicatrization is 
soon accomplished." 

The most serious compHcation usually met with is the section 
of the facial and sub-zygomatic nerves, which is followed by par- 
alysis of the face and lips on that side. Director Degives divides 
the operation into three steps. The first includes the incision 



OPERATIONS ON THE TONGUE. 363 

and dissection of the skin. The incision is made lengthwise, from 
the base of the ear down to the middle of the external face of the 
gland, that is, as far as below the glosso-facial vein, and involving 
the sMn and the parotido-auricularis muscle, the dissection of the 
skin being made a little beyond the borders and extremities of 
the skin. The dissection of the gland forms the second step, and 
must be as complete as possible. There are some parts where 
the gland is difficvdt to isolate, especially at the base of the ear, 
at its masseterine adhesions near the sub-zygomatic blood vessels 
and nerves, but at these points some Httle glandular granulations 
may be left. In this dissection the use of the fingers or of the 
dull end of the handle of a dissecting scalpel is recommended in 
order to avoid the blood vessels and nerves which are so intimately 
connected with the organ. 

Beginning with the ligation and section of the posterior auric- 
ular vein, the anterior border of the gland is isolated from above 
downward, carefully avoiding the sub-zygomatic blood vessels 
and nerves, after which the jugular vein is isolated in the whole 
extent of its parotid course, and the gland divided into two por- 
tions, one above, the other below the vein. The dissection of the 
upper portion is made from below upward, avoiding first, four ar- 
terial divisions, including the external carotid, the temporal trunk, 
the internal maxillary, and the posterior auricular ; secoiid, the 
superficial temporal and the facial nerves ; and third, the guttural 
pouch, which is intimately adherent to the internal face of the 
gland above. The smaller arterial branches that are divided are 
hgated or twisted. The lower portion is then carefully dissected 
from above downward. The dressing of the tcoitnd, which is the 
third step, is performed according to the process of Brogniez. 

Maxillary Adenotomy. 

We find but a single description of this operation, which is by 
Director Degives in his Manuel de Medecine Oj^eratoire Veteri- 
naire. Kecommending it only as the last treatment in the re- 
fractory fistula of Warthon's duct, he first divides the skin and 
the cutaneous muscle against the inferior border of the gland, 
parallel to the glosso-facial vein, and makes an incision about four 
inches long, which brings him to the loose and abundant cellular 
tissue which surrounds the gland. The dissection is made with 



364 OPERATIONS ON THE DIGESTIVE APPARATUS. 

the fingers by tearing the connective tissue in the middle part 
of the gland ; when taking hold of it at that place it can be care- 
fully pulled out, the division of the cellular tissue which holds it 
being easily detached with the fingers or a blunt instrument. The 
position of the wound is such that no special dressing is indicated, 
suppuration having a free exit. 

OPEKATIONS ON THE CESOPHAGUS. 

The surgical affections which require interference with the 
oesophagus and adjacent regions are classified as foUows: Bruises, 
wounds, lacerations, ruptures, tumors, jabot, obstructijon by for- 
eign bodies or alimentary masses, and strictures. The various 
operations of direct apj)lication which are indicated in connection 
with these casualties are: Catheterism of the oesophagus, the 
taxis, the crushing of the foreign bodies, and oesophagotomy. This 
classification, arranged by Peuch and Toussaint, meets with our 
acceptance, including the operations enumerated, and in our con- 
sideration of the subject we shall, for the jDresent, refer our 
readers for descriptions of the various forms of disease to the 
standard authorities upon veterinary medicine, especially includ- 
ing in the list the excellent work of Professor Williams. 

Before entering upon a description of these operations, a re- 
view of the surgical anatomy of that organ will be in place. 

The oesophagus is a long musculo-mucous canal, which at the 
third step of deglutition carries the food, both liquid and solid, 
from the pharynx to the stomach. Stretched between these two or- 
gans, it successively occupies the neck down its inferior region, the 
entire length of the thorax, and a small portion of the abdomen. 
At its origin (Fig. 362), situated on the median line, it communi- 
cates with the pharynx by an opening above the glottis; from 
thence it runs obliquely downward, from before backward, be- 
hind the trachea, until about the middle of the neck, where it 
begins to deviate to the left, resting from thence on that side of 
the trachea. In this situation it enters the thorax, to resume its 
former position on the trachea; passes above its bifurcation and 
the base of the heart, running through the layers of the posterior 
mediastinum, which covers it, reaches the right pillar of the dia- 
phragm, and passes through it, and entering the abdomen, has its 
termination on the left side of the small curvature of the stomach. 



OPEKATIONS ON THE (ESOPHAGUS. 



365 




Fig. 362.— Anatomy of the CEsophagus and Jugular Vein of the Horse. J J, Jugular 
vein; C, carotid artery; O 11, sub-scapulo hyoideus muscle ; D, oesophagus; S, sterno- 
maxillaris muscle ; M, mastoido-humeralis muscle. 

The relations of the oesophagus must then be considered accord- 
ing to its divisions of the cervical, thoracic and abdominal portion. 
At its point of origin, at the pharynx, it is situated between the 
larynx and the guttural pouches. In the upper half of the neck it 
is in relation, in front, with the trachea; behind, with the long 
muscle of the neck; and on the side with the car tid and its 
sateUite nerves. Below this point, and as it deviates to the left, 
it is related to the left side of the trachea, upon which it rests, 
and on its outside, with the scalenus muscle, the carotid artery and 
the jugular vein. In a very few instances, instead of passing to 
the left of the trachea, it deviates to the right, but otherwise holds 
the same relations as when in its normal position. At its entrance 
into the thorax, the oesophagus, still on the side of the trachea, 
corresponds outwardly with the inferior cervical ganghon and its 
branches, and to the vertebral, superior cervical and dorsal arteries 



366 OPERATIONS ON THE DIGESTIVE APPARATUS. 

and veins, which cross its course and further back, returning be- 
tween the trachea and the longus colli, it passes over the left bron- 
chia and to the right of the thoracic aorta. Beyond this, placed 
between the folds of the posterior mediastinum, it is received 
into the groove of the internal face of the lungs, with the oesoph- 
ageal arteries and nerves. Passing through the opening of the 
right pillar of the diaphragm, we find it in its abdominal portion 
related on the right to a notch of the superior border of the hver, 
and ending at the cardiac. The structure of the oesophagus is 
formed of two coats ; one of external and muscular, the other 
of internal and mucous membrane. The external is composed 
of muscular fibers, spiral, red and longitudinal, striated in 
its anterior three quarters, and white in the posterior quarter. 
Anteriorly, the crico-pharyngeus furnishes it with a sort of circu- 
lar necktie. Towards its posterior portion, the muscular coat is 
much thicker than in the other parts, and as it passes through the 
pillars of the diaphragm, it is more or less pressed upon. These 
three points must be remembered, inasmuch as they serve to ex- 
plain the resistance which is encountered by instruments, such 
as the catheter, or the probang, when introduced into its cavity. 
The internal coat or mucous membrane is whitish, with longi- 
tudinal folds, which are so developed at the cardia that they may 
resist the passage of the probang into the stomach. 

(Esophageal Catheterism 
is an operation consisting in the introduction of a special instru- 
ment, solid or hollow, but always flexible, into the cavity of the 
oesophagus, either to remove bodies that obstruct it, or to aid the 
exit of gases which have accumulated in the stomach. 

It is therefore indicated in three principal conditions, viz.: 
first, tympanitis in ruminants ; second, in cases of oesophageal 
dilatation, ov jabot ; and third, to dislodge foreign bodies arrested 
in its canal. 

In cases of tympanitis^ it is of advantage if the trouble is not 
too far developed, and danger of suffocation not too imminent. 
In cases of oesophageal jabot, due to a more or less extensive 
dilatation of the organ, in consequence of the lodgment and 
packing of food, it is in many instances of but very little benefit. 
When foreign bodies are lodged in the oesophagus, an accident 
to which horses are liable, and which is very common in cattle 



OPERATIONS ON THE CESOPHAGUS. 



367 



and in clogs, it is often of great 
advantage. The operation would 
naturally depend very lai-gely for 
its success upon the size of the 
foreign body, which of course is a 
variable circumstance, and also on 
the condition of its external sur- 
face, whether rough or smooth, or 
having projecting points ; depend- 
ing much likewise on the situation 
in the length of the canal, and 
whether it has become engaged in 
the cervical or the thoracic portion 
of the passage. 

Probangs for the throat and a 
speculum for the mouth are instru- 
ments necessary for this operation. 

There are various forms of pro- 
bangs, the designs of different in- 
ventors. The first, which, accord- 
ing to Brogniez, was invented by 
Mom-o of Edinbm-gh, has been 
more or less perfected. The pro- 
bang of Baujin (Figure 3G3) is re- 
versible, and may be so adjusted 
as to either push down or extract 
the offending substance from its 
place of lodgment. The instru- 
ment in ordinajry use is designed 
essentially to push the obstruction 
through the passage. It is found 
in all oiu' surgical instrument ma- 
kers' shops, and is made of whalebone or of rubber, separable in 
two parts, connected by a screw. One end (Fig. 364) has a bulb- 
ous enlargement, the other a blunt mass or head, made concave 




Fig. 363.— Baujin's Probang. 



Fig. 364.— Ordinary Whalebone Probang. 



368 OPERATIONS ON THE DIGESTIVE APPARATUS. 

on its free end, the better to act without slipping against the ob- 
ject with which it is to come in contact. The probang of the 
stomach pump forms an excellent instrument for that purpose. 

Dr. Peabody has constructed a simple implement of strong, 
thick wire, twisted together and forming a rod of sufficient length, 
protected by a tube of India rubber, and having one end formed 
into a ring or loop, to serve as a handle, while at the other ex- 
tremity a sponge of suitable size is secured and formed into a 
bulb resembling that of the ordinary probang. Degives recom- 
mends for use in cases of emergency an extemporized instrument, 
formed of a whip handle or a branch of a tree, of sufficient 
length, of the size of the little finger, with a bulb composed of a 
ball of oakum covered with cloth. This bulb is attached to the 
end with strong twine, of which a free end is left of equal length 
with the instrument, in order to draw out the broken fragments 
in case of fracture of the probang. 

Whatever form of probang may be used, it is always neces- 
sary to associate with it a speculum to keep the mouth sufficiently 
open and immobile. Those which are recommended and em- 




FiG. 365.— Brognlez's Gag. 

ployed in the exploration of the mouth are available for this pur- 
pose. But as these are not always obtainable, some iagenious and 
simple apparatus can be made at a moment's notice like that illus- 
trated in Figure 365, which, or something equivalent, ought to be 
within the scope of the inventive and constructive capacity of any 
well equipped surgeon. 



OPERATIONS ON THE CESOPHAGTJS. 369 

In ruminants the operation is performed in the standing posi- 
tion, mth the head extended and elevated on the neck. In soli- 
peds it cannot be performed except while the animal is down, and 
when the head can be placed in the proper position of extension 
to allow the instrument to pass beyond the elbow formed by the 
pharynx and the oesophagus. The animal being in position, and 
the speculum adjusted, an assistant draws the tongue out of the 
mouth, and the operator, placed in front of his patient, passes the 
probang through the opening of the speculum, and rapidly pushes 
it into the mouth, resting it upon the hard palate, in order to pre- 
vent its being displaced laterally by the motion of the tongue. At 
the bottom of the mouth the probang meets with some Httle re- 
sistance at the soft palate, but the instrument soon reaches the 
fauces, in the pharynx, and penetrates the oesophagus. At this 
moment possibly some resistance may be encountered, owing to 
the contraction of the crico-pharyngeus miiscle, but once engaged 
in the oesophagus the instrument readily passes the proj^er dis- 
tance downwards, according to the requirements of the case. If 
the object in \iew is to relieve tympanitis, and a true catheter, 
tube, or stomach pump or hoUow probang has been used, the 
gases will find a means of exit as soon as the instrument has 
penetrated the stomach. 

If the catheterism has been performed for the displacement of 
foreign bodies, the resistance they offer to the pressui-e of the 
probang must be overcome by a steady, and, at times, quite a 
powerfiil pressure of the instrument, caution being always neces- 
sary to avoid causing laceration of the wall of the passage. When 
the obstruction is even but sHghtly loosened, its complete dis- 
lodgment often follows from the mere unassisted contraction of 
the oesophageal muscles. Caution and gentleness must not be 
overlooked even in the mere withdrawal of the probang. It 
should be practiced as a maxim, indeed, that whatever instrimient 
may be, for any pvirpose, made use of, not alone in the propulsion 
of the intruding body in these cases, the operator must never re- 
mit his caution and gentleness, nor lose sight of the fact of the 
natural Hability to accident always accompanying svii*gical in- 
terference with the organs and tissues having their place in the 
interior regions of the animal organism, and not cognizable by 
the eye. Serious accidents have been recorded as resulting from 
a lack of care and attention in the manner of withdrawing the in- 



370 OPERATIONS ON THE DIGESTIVE APPARATUS. 

strument. Lacerations of the oesophageal walls, rupture of blood 
vessels, jierforation of the trachea, abscesses of the mediastines, 
pleurisy and pericarditis belong to the list of recorded casualties 
in this connection. To facilitate the working of the probang, in 
these cases, certain practitioners have recommended the adminis- 
tration of oil or mucilaginous drenches. 

The Taxis. 

The oesophageal catheterism which we have just considered is 
principally applicable to cases where the obstruction is in the 
thoracic portion of the passage. When it is in the cervical por- 
tion, instead oi jyrojyulsioyi or intrapulsion, it is by extrajyulsion, 
or by the course of the natural passages that the foreign body is 
to be removed. In this case the taxis is made to take the place 
of the ordinary artificial appliances, and the hands become the in- 
struments with which the surgeon seeks, by making forcible and 
methodical pressure, to move the impacted object back into the 
mouth. 

In 1820, Delafoy recommended a process which is to-day ad- 
mitted to be one of the best modes of relieving cattle when suf- 
fering with this difficulty, and many other methods have since 
then been devised, but most of them are merely modified plans of 
Delafoy's method. We shall consider them as briefly as possible. 
In, order to raise the itnpact (as we shall for convenience call it) 
back into the pharynx, Delafoy has the animal thrown, on the 
right side, and administers a glass of sweet olive oil, and while 
an assistant steadies the oesophagus, applies with his fingers upon 
the impact, a retrograde motion which carries it upward, back 
and to the pharynx. When it reaches that cavity, the head is 
raised, the jaws are opened with a speculum, and the operator, 
passing his hand through that instrument into the back of the 
mouth, seizes the impact and brings it away. Lindenberg keeps 
the patient on his feet instead of casting him, but otherwise ob- 
serves the same modus operandi. Denenbourg operates with his 
patient in a standing position. While an assistant holds the 
head, well extended, and elevated on the neck, he places himself 
on the right side of the animal, and with the fingers pressing be- 
low the impact (like Delafoy), displaces it and gives it the as- 
cending motion which transfers it to the pharynx, and keeps it 
there by pressing hard below it. Then putting an assistant in his 



OPERATIONS ON THE (ESOPHAGUS. 371 

place he proceeds like the others to remove the impact with the 
hand passed through the speculum. 

Schaack operates also in the standing position, the hind legs 
being hobbled above the hocks, the head is kept, as much as pos- 
sible, in a horizontal position, and a speculum placed in the 
mouth. The oj)erator takes his place on the left side, in front of 
the shoulder, the right hand on one side of the neck, the left on 
the other. If the impact is rather low down, or near the chest, 
the extremities of the fingers are brought together and employed 
to push it upward, with careful manipulations. If it is situated 
higher up, near the oesophagus where it is less surrounded by 
muscles, the pressure is made with the fingers closed. In either 
case, however, when it has reached the throat, Schaack holds it 
there, while an assistant with his hand boldly introduced into the 
mouth, seizes it and di'aws it out of the pharynx. 

According to Peuch and Toussaint, Mr. G. Tisserand, in cases 
of jabot, operates as follows : Making a point of support on the 
neck vnth. the right hand, with the left he violently shakes the 
part where the projection of the jabot is most prominent, and 
then apphes alternate movements, up and down, with a lateral 
shaking of the enlargement until the patient voliuitarily lowers 
his head, and as he snufiles throws out through the nostrils and 
the mouth, abundant mucosities, mixed with alimentary detritus. 
If the first manipulations fail, Tisserand advises the occasional ad- 
ministration of mucilaginous decoctions, or oil, or even plain water. 

The method of Martin is one which is also held in high esteem, 
and at the hazard of needless repetition and unnecessary minutiae 
we give it in detail. Instead of extending the head, which has a 
tendency to stretch the oesophagus and diminish its diameter, he 
keeps the head of the patient low down, at about a foot from 
the ground, and placing himself on the left side of the neck, he 
passes his right arm over the neck, in such a manner that envelop- 
ing the neck between both arms, his hands can join on the lower 
border of the neck, and both thumbs jjressed in the jugular 
grooves, one on the right, the other on the left. It is by succes- 
sive pressures from behind forward, that he succeeds in pushing 
the impact in the pharynx. Then comes a peculiar step of the 
operation : As by its presence the soft palate closes somewhat the 
posterior opening of the mouth, the impact cannot re-enter this 
cavity, and thus, while the mass is in the pharynx and resting on 



372 OPERATIONS ON THE DIGESTIVE APPARATUS. 

the posterior face of the velum palati, with both thumbs he pushes 
it from above downward and from behind forward; the effect 
of this is to depress the base of the tongue, and to enlarge the 
isthmus of the throat sufficiently for the impact to pass through 
it, back in the mouth, and drop it to the ground. If, however, the 
pressure required in this step of the operation could not, for one 
reason or another, such as excessive thickness of the lower border 
of the neck, for instance, be maintained, then the impact is ex- 
tracted with the hand. 

Courioux has advised the application of a cord around the 
neck, below the impact to be moved upwards with it, as the dis- 
placement is accomplished. The object of this is to retain what- 
ever progress may be gained by preventing the mass from re- 
ceding again. It forms a substitute for the fingers in holding it 
in position. 

The extraction by the mouth of many substances arrested 
in the oesophagus has also been effected with instruments. 
Forceps long and curved, hooks and hollow sounds, having metal- 
lic nippers or jaws, like that of Baujin, have been recommended. 
That of Wegerer is probably entitled to the highest commenda- 
tion of all. But with all then- ingenuity and perfection their use 
is not without danger of causing lacerations of the oesophageal 
walls, and they are constantly liable to get out of order. 

Crushing the Foreign Body. 

At times the obstruction takes place in the cervical portion of 
the oesophagus, and attempts to displace it, either toward the 
mouth or the stomach, have failed. To meet this emergency 
various means have been sought for, either to crush the impact, or 
cut it in small pieces. One suggestion for the first object is to 
break it with blows of a mallet, a piece of wood, or other object 
held by an assistant, furnishing the point of resistance. But this 
is obviously a dangerous process, nearly certain to produce 
bruises and lacerations of the soft structures, with probably sub- 
sequent gangrene. At best it can be available only when the im- 
pact is in the form of a comparatively soft mass, such as ripe fruit 
or the like. 

Professor Lafosse had in 1846 suggested subcutaneous incis- 
ion, and this was put in practice in 1855 by Chapard for the relief 
of a cow choked by a piece of a beet. A simple puncture of the 



OPERATIONS ON THE (ESOPHAGUS. 373 

oesophagus was first made, with a straight tenotome, below the 
obstruction, then a curved tenotome was introduced through the 
wound, and by careful movements in the mass of impact, it was 
sufiiciently divided to enable it to resume its usual course down- 
ward into the rumen. Though this mode of operation has not 
become established in general practice, the application of its prin- 
ciple has not been overlooked, and has not been without its influ- 
ence in simplifying the performance of the operation of oesopha- 
gotomy. 

CESOPHAGOTOMY. 

When the obstruction is in the cervical portion of the oesopha- 
gus, and, either because of its nature or of its form, cannot be 
displaced by any of the means we have discussed, the division of 
the organ itself furnishes the only escajoe from the consequences 
of the difficulty. The operation of cesophagotomy consists in the 
exposure of the oesophagus and the incision of its walls. While 
it is usually performed for the removal of obstructing bodies, it is 
also indicated in some cases as a mode of facilitating the adminis- 
tration of drugs, or, under special circumstances, of food and 
drinks. 

It is of French origin, and its adoption in veterinary surgery 
seems to have occurred in 1782, when it was performed by Lom- 
pagieu Lapole to remove an orange, arrested in the inferior region 
of the neck. Since that epoch it has been performed on horses, 
cattle, dogs, and even on swine. Damoiseau, Fehx, Michel and 
others have performed it on cattle ; Thissine, H. Bouley, Reynal, 
Rey, Marrel, Mauri on th6 horse ; Peuch, MacgiUivray, WOHams, 
on dogs, and Lagrange on pigs. H. Bouley performed it to re- 
move a piece of corncob and a large molar tooth which, after ex- 
traction, had sHpped into the oesophagus; Baldwin extracted a 
large piece of a root; Rey removed a cork; Peuch took away 
pieces of bone from a dog. In fact, the operation has generally, 
if not exclusively, as is but natural, been appropriated to the relief 
of patients laboring under the difficulty we have been discussing. 
A claim has been made in its behalf as a means of relief in lock- 
jaw, by facilitating the artificial feeding of the sufferer. But such 
a claim, as to any practical value which may be supposed to attach 
to it, cannot in anywise possess any validity, nor be to any extent 
sustained when we take into consideration the history and the 



374 OPERATIONS ON THE DIGESTIVE APPARATUS. 

nature of tetanus and its origin, with the complications and con- 
sequences likely to accompany and to follow it. Marrel has rec- 
ommended it in cases of fractures of the jaws ; but such practice 
would truly furnish an example of the proverbial case in which 
the remedy is worse than the disease. It has also been recom- 
mended for the rehef of jabot, and has been, in some cases, fol- 
lowed by favorable results. 

The instruments necessary for this operation are a convex and 
a straight bistour}^ a pair of dissecting forceps, a director, a needle 
and strong thread ; to these may be added a pair of scissors and 
two blunt tenaculums, with also large forceps to grasp the impact 
and extract it, close at hand. The animal must be kept in the 
standing position, and held under thorough control by an assist- 
ant, with a twitch on the lower lip or on the ear, and either fore 
foot raised or both fore legs hobbled. 

It must be taken into consideration that the cervical portion 
of the oesojjhagus is situated immediately behind the trachea, con- 
tinuing thence as far as the middle of the neck, when it deviates 
to the left, where it occupies the lower third of the neck ; and 
again, that this cervical region is surrounded by an abundance of 
loose connective tissue, having on each side the carotid and its 
nerves. It will also be observed that the lower third of the neck 
forms a triangular space, with above it the inferior border of the 
sub-scapulo-hyoideus muscle, and on the sides the sterno-maxil- 
laris, levator-humeri and scalenus. In this space it is in connec- 
tion on the inside vnth the trachea, upon which it rests ; and on 
the outside with the scalenus, the carotid, the jugular and the 
nerves of that region — organs which are all covered by the cuta- 
neous colli and the skin. 

The point of separation of the middle and lower third of the 
neck, in the left jugular groove, is the place of election or of ne- 
cessity for the operation, or where the incision of the skin must 
begin, a little above and behind the jugular. If the obstruction 
is considerably prominent, this incision must be made directly 
over it. 

Peuch and Toussaint, in their excellent work, divide the oper- 
ation into three steps, which they thus describe : — 

1st. Step. Incision of the skin and dissection of the subja- 
cent tissues. — Standing on the left side, the operator first deter- 
mining the situation of the jugular vein, cHps the hair from over 



OPEKATIONS ON THE OESOPHAGUS. 



375 



the tumor, stretches the skin with the left thumb and index 
finger, and with the convex bistoury, extends the incision from 
the initial point, about four fingers' breadth down, parallel with 
the blood vessels. The incision divides the skin, and the cuta- 
neous muscle, and exposes the jugular and carotid and their nerves. 
The thumb of the left hand is then introduced into the incision 
and depresses forward the blood vessels and nerves, while the 
other fingers of the same hand are embracing the tracheal border 
of the neck. The oesophagus is thus exposed on the lateral 
border of the trachea, and the cellular tissue which covers the 
organ is then divided. By raising the upper lip of the incision 
with a blunt tenaculum the oesophagnis may be still more exposed. 
2d Step. Loosening or isolation of the oesophagus — Cutting 
away part of the cellular tissue, the oesophagus is seized with 
the thumb and index of the right hand and drawn outward. The 
vascvilo-nervous fasciculus are then let loose, the oesophagus is 




Fig. 366.-1116 (Esophagus Drawn Outward and Raised with the Scissors. 



376 OPEBATIONS ON THE DIGESTIVE APPARATUS. 

drawB out with the left hand, the right holding the curved scis- 
sors, which being passed from above downward, and separating 
the remaining portion of cellular tissue, holds the organ resting 
upon its blades, in readiness for the thh-d step (Fig. 366). 

3d Step, or Incision of the msophagus. — The operator then, 
supporting the scissors with the oesophagus resting upon them, 
in the left hand, with a straight bistoury with the edge turned 
upward, in the right, makes a large puncture in the oesophageal 
walls, passing through their entire thickness, and afterwards en- 
larging it with the aid of a director. At this point of the operation, 
and at each deglutition, there is usually an escape of mucosities 
mingled with food. When the impact forms a decided projection, 
the incision should be made directly over the promiaence. 

Professor Nocard has modified the operation in cases where 
the obstruction can be divided in small j)ieces, by making only a 
coiTespondingly small incision. He uses both a straight and a 
curved tenotome, and performs the first and second stejDs as in 
the preceding methods, the third one being made as follows: 
"The oesophagus being exposed, isolated and placed over the 
scissors, the operator introduces the sti-aight tenotome through 
the oesophageal membranes, the blade running parallel with the 
muscular fibers, into the thickness of the impact (apple, potatoe, 
pieces of beet, etc.,) avoiding injury to the opposite surface of the 
canal; then sliding the curved tenotome against the straight one, 
and pushing it through the entire mass until it touches the op- 
posite wall of the oesophagus, he withdraws the straight instru- 
ment, and divides the impact by movements of the curved instru- 
ment, analogous to those made in the division of the tendons in 
the operation of plantar tenotomy. The blunt end of the curved 
tenotome jjrotects the oesophagus from any enlargement of the 
original wound." 

Cagny, after exposing the oesophagus, as already described, 
crushes the obstruction by repeated gentle blows of a small 
mallet, as before described. He prefers this mode to that of in- 
cision if the impact, though hard and flat, possesses but little force 
of adhesion. When the objects of the cesophagotomy have been 
reahzed, there is no necessity for further interference, the appli- 
cation of sutures being generally considered rather injurious than 
otherwise, and though the resulting wound is of a somewhat com- 
plicated nature, its perfect cicatrization in a comparatively short 



GASTKOTOMY. 377 

time is the general rule. The principal indication is cleanliness in 
the removal of the discharges, and of any mucosities or food that 
may escape over its surfaces. H. Boviley has experimentally 
proved that to obtain the cicatrization of oesophageal wounds it is 
essential '■Ho feed the animals loith food of fibrous texture, and 
nothing but pure water to drink."' By respecting this indication 
all danger of comphcations is avoided. 

The possible accidents and complications are : wounds of the 
blood vessels during the first steps of the operation, but the 
hemorrhage that follows may be stopped by pressure or ligature ; 
(edematous swelling of the wound, suggesting the infiltration of 
food or pus in the surrounding cellular tissue. It may terminate in 
a simple abscess, or it may be the precursor of a fatal gangrenous 
complication: purulent infection, septiccemia, tetanus, are also 
possible sequelae of oesophagotomy, but a faithfvd and judicious 
appHcation of antiseptic means in dressing and nursing the 
patients will usually baffle the possible evil. 

GASTROTOMY— RUMENOTOMY. 

This title, in our opinion, ought to include the puncture or in- 
cision of the rumen, when designed to Hberate confined gases or 
to remove the solid contents which may have accumulated in that 
viscerse. In the first case it is indicated when the tympanitic 
condition of the first compartment of the stomach exhibits 
alarming s^inptoms and resists all ordinary remedial indications ; 
and in the second, when the gases of the rumen are mixed with 
the aUmentary mass contained in that organ and a larger opening 
than that made by the trocar becomes necessary, for their re- 
moval. In either case the left flank must be the seat of election 
for the operation, the rumen occupying that side of the abdomen, 
and situated at a point equally distant from the last rib, the 
angle of the ilium and the transverse process of the lumbar 
vertebrae. Tabourin suggests the last intercostal space as the 
proper place for the operation. The instruments necessary are a 
large trocar (Fig. 367) with a straight and a curved bistoury. The 
gastrotomes invented by Brogniez (Fig. 368) and Sajoux are too 
comphcated. The animal must be in the standing position. 

Puncture of the rumen. — The operator, facing the left flank, 
makes an incision through the skin, about an inch and a half long, 



378 OPEEATIONS ON THE DIGESTIVE APPARATUS. 




Fig. 367.— Large Trocars. 

with the bistoury, or with the blade of a lancet. Then placing 
the trocar perpendicularly upon the flank and into the cutaneous 
incision, jjresses it against the muscles, and with his right hand 
strikes a heavy blow on the handle of the instrument and forces 
it into the cavity of the rumen, provided the blow has been suffi- 
ciently heavy. The blade of the trocar is then withdrawn, the 
canula being left in j)lace, and the gases allowed to escape, as 
in the operation of enterotomy. 

Incision of the rumen. — The operator, using a convex bistoury, 
makes an incision in the middle of the left flank, beginning a little 
below the point selected for the puncture of the rumen, and 
measuring a length of from three to four inches, cuts through 
and divides the entu-e thickness of the skin, and the walls of the 
rumen. The hand is then introduced and employed for the re- 
moval of the food contained in the cavity. The further cleaning- 
out of the rumen may be done vdth a large spoon. Schaack 
recommends the removal of only a limited portion of the ferment- 
ing mass, and that the walls of the organ should not be scraped. 

While the puncture of the rumen does not require to be fol- 
lowed by any special subsequent treatment, the wound of the in- 
cision needs to be closed immediately after the removal of the 
contents of the organ. This must be attended with every anti- 
septic precaution, and the closing be done by means of the inter- 
rupted suture. The parts should be thoroughly cleansed. Adhe- 
sion may be promoted by the application of a wide band of ad- 
hesive plaster placed all round the animal, as recommended by 
Professor Brush of the American Veterinary College. The wound 
of the puncture heals rapidly, while that of the incision requires 
from a week to ten days, and if proj)erly treated, unites by the 
first intention, without suppuration. The accidents which are 



GASTKOTOMY. 



379 




Fig. 368.— Brogniez's Qastrotome. 

likely to follow these operations are subcutaneous emphysema, 
abscess, or peritonitis. The first of these is not uncommon, or 
dangerous; the abscesses are comparatively rarer ; the peritonitis 
generally proves fatal. 



380 OPERATIONS ON THE DIGESTIVE APPARATUS. 



ENTEROTOMY. 

The division or puncture of the intestines, or enterotomy, 
is an operation the object of which is to facilitate the exit of gases 
contained ia these organs, to prevent their excessive dilatation, 
and to obviate certain too commonly fatal compHcations. It was 
mentioned at an early day by Vegetius, especially in connection 
with the treatment of wind colics, but not again spoken of until 
1776, when Roem, Bomvinghausen, and at a later date, Barrier 
and Herouard obtained good results from it. Bourgelat and 
Chabert recommended it in the early stages of the disease, but, 
notwithstanding the favorable dicta of all these authorities, the 
operation was not fully admitted to a place in the domain of 
veterinary surgery until Bernard, Dieterichs, Falke, Rey, Schaack, 
Hayne, Eckel, Blendeiss, Charlier and others, had proved by nu- 
merous facts that when j)erformed under favorable circumstances 
it is not only harmless, but is capable of insuring results of the 
most beneficial character. 

Intestinal puncture is radicated in cases of tympanitis or flat- 
ulent coHc, due to indigestion, or to an intestinal obstruction, 
and must be performed whenever the accumulation of gases has 
resisted ordinary forms of treatment. The indication, in our opin- 
ion, is to operate early in the disease, as an almost positive means 
of avoiding the complications, or rupture of the stomach or lacera- 
tion of the intestines, which, if unchecked, may accompany the flatu- 
lent accumulation. Enterotomy is also recommended in cases of 
strangulated hernia, when the gases which are imprisoned in the 
hernial intestines prevent its reduction. Imbert used it with ad- 
vantage in reducing a strangulated ventral hernia. In former 
days Chabert performed the operation through the rectum, and 
Abadie, in 1875, reported a case in which he reached the intes- 
tines through the vagina. But while it may be possible to ob- 
tain access to the dilated iatestines through these channels, it 
is evident that it is a method which must oppose more difficul- 
ties and involve more compHcations than the pvmcture through 
the flank. 

The point of selection for the operation is about the center of 
the space formed forward by the border of the last rib, behind by 
the external angle of the ilium, and above by the extremity of the 



ENTEKOTOMY. 



381 





Fig. 369.— Trocars for the Coecum. 



Fig. 370.— Brogniez's Enterotome. 



transverse processes of the lumbar vertebrae, on the right flank — 
since it is there that the dilatation of the intestines is most prom- 
inent. The puncture, if made at this stated point, penetrates the 
second portion of the large colon ; if it is made nearer the lumbar 
vertebrae, it enters the arch of the coecum. 

The only instrument necessary to perform enterotomy is a 
trocar. The instrument used in cattle for puncture of the rumen 



382 OPEKATIONS ON THE DIGESTIVE APPAKATUS. 

was formerly employed, but it is quite unnecessary and of no ad- 
vantage to use a canula of such dimensions merely to allow the 
escape of the gases. A small, round trocar is now in general use, 
and is in our estimation to be preferred to the ordinary flattened 
form of instrument (Fig. 369). The enterotome of Brogniez (Fig. 
370) is too large an instrument, and its use endangers the walls 
of the intestines and the surrounding blood vessels. 

Brogniez reports a case of injury to one of the ccecal arteries 
by the point of this instrument. We have frequently had re- 
course to the trocar of the epidermic syringe used for horses, 
when no other instrument was conveniently at hand. 

The animal suffering with flatulent colics is treated while on 
its feet, and the pain it endures is usually of so intense a kind 
that no means of restraint are necessary, and it remains per- 
fectly indifferent to the insignificant and minor pang of the oper- 
ation. The principal caution to be observed, is to be on guard 
against the patient's suddenly falling, but if this should occur it 
need not interrupt the operation, which may be continued with- 
out forcing it to rise. 

The modus operandi is very simple. The spot being acurately 
determined, the point of the instrument is pressed perpendicu- 
larly upon the skin with one hand, and driven by a strong, quick 
blow with the other upon the handle, through the skin and the in- 
testinal coats into the visceral cavity. The withdrawal of the rod, 
leaving the canula in place, completes the process, by giving vent 
to the gases. These escape with more or less force, as announced 
by a whistling sound as they pass out of the tube. The intestines 
must then be entered from above downward, and not as recom- 
mended by Hertwig, who punctures the most dependent part of 
the abdomen, and thus exposes his patient to serious subcutaneous 
infiltrations. 

Peuch and Toussaint suggest the propriety of making a 
smaU preparatory incision through the skin with a bistoury, pre- 
vious to the main puncture with the trocar. The escape of the 
gases continues for a varying time, according to the amount of 
the accumulation. The instrument should continue in the 
wound while the escape continues, and until the tympanitic con- 
dition of the intestines disappears. If the escape of gas should 
suddenly cease, it will be because the canula is filled with foecal 
or other matters, and the trocar must be re-inserted into its 



PARACENTESIS. 



383 



canula until the renewed escape of the gas proves that the ob- 
struction has been removed. If, however, they still fail to find an 
exit through the canula, a second puncture must be made at a 
short distance from the first. The wound of the puncture re- 
quires no treatment. 

According to Zundel, enterotomy is comparatively — in ordin- 
ary cases — harmless; still, however, complications more or less 
severe are possible, and have been observed. Hemorrhages, 
though of no alarming nature, have been noticed, and several 
cases of abscess have been recorded, either at the seat of the 
operation, or at the wound of the flank, and even in the groin. 
Peritonitis has also been encountered. Subcutaneous emphysema 
has been mentioned by Bouley ; but in an experience of many 
years, we have never seen it. Laceration of the floating colon has 
been reported by Schaack. As a means of prevention against 
these accidents we would recommend great care in the introduc- 
tion of the trocar through the abdominal walls, and especially a 
condition of thorough cleanliness, with a careful disinfection, of 
the instrument. 

PAEACENTESIS. 

This term, with its synonyms of puncture and tapping^ is at 
the present time appHed exclusively to the operation performed 
upon the abdominal walls for the purpose of evacuating the seros- 
ity collected in the peritoneal cavity, as the result of dropsical ef- 
fusion. It consists in puncturing the abdominal walls in the man- 
ner practiced in enterotomy and gastrotomy. The operations are 
similar, while the purpose varies materially in the several cases. 

This operation had already been recommended by Vegetius — 
afterward employed by Vitet, as a last resort in ascitis. Lafosse, 
Jr., also speaks of it, and in more modern times we find it advo- 
cated by St. Cyr, Lafosse, Forster and others. Though in the 
majority of cases forming only a palliative treatment, it is never- 
theless indicated in chi'onic dropsy of the abdomen, when all 
other forms of treatment have failed to produce the resorption of 
the fluid, especially when its accumulation interferes with the ab- 
dominal and thoracic functions. In these cases of ascites it has 
been performed upon horses, cattle and dogs. The injection of 
tincture of iodine into the j)ei"itoneal cavity, after the removal of 



384 OPEKATIONS ON THE DIGESTIVE APPARATUS. 

the e£fusion, has been successfully added as a means of preventing 
the return of the fluid. 

In selecting the place where the operation is to be performed, 
Brogniez, Degives, Peuch and Toussaint advised the middle of 
the linea alba, at an equal distance from the xiphoid cartilage of 
the sternum and the anterior border of the pubis ; Zundel, on the 
contrary, recommends " a punctxire on the right side in ruminants, 
on the left in horses, on a point at an equal distance between the 
umbiHcus and the external angle of the ilium, about on a line run- 
ning from the stifle towards the cartilage of the last rib." He 
adds, however, "to select the point where the hquid is most de- 
tectable and fluctuation better felt." 

A trocar of the size of a quill for large animals, and an aspirator 
for the small, are the only instruments required. In operating on 
large animals, they are kept standing, while small animals are laid 
upon a table and placed slightly on their backs. Placing himself 
on the left side of the animal, after having selected the place 
where the puncture is to be made, the operator, holding the trocar 




Fig. 371.— Holding the Trocar in Paracenthesls. 



full in his hand and hmiting its action by keeping his fingers a 
short distance from the point of the instrument, pushes it by a 
rapid and firm pressure through the thickness of the abdominal 
walls, until he feels that he has overcome their resistance, and that 
the instrument has passed into the cavity. The trocar is then 
withdrawn from its canula and the fluid escapes through the tube. 
Director Degives describes another modus operandi, which he 
calls subcutaneous, in which the opening of the skin does not cor- 
respond with the division of the deeper muscular layers, and by 
which the opening becomes covered by the skin. To effect this 
the skin is drawn a little aside, then punctured, or a large fold of 
the tegument is taken hold of, and the puncture made at its base. 
In either case, when the skin is loosened, its retraction completely 
closes the abdominal opening. 



HERNIA. 385 

If the escape of the fluid should stop or diminish, a blunt 
stylet can be introduced into the canula to clean it of any albu- 
minous or epiploic mass which may obstruct it. The operation in 
small animals is performed in the same manner. 

As the removal of the entire accumtdation of the fluid is dan- 
gerous, though less so than ia thoracentesis, it is better to permit 
a portion of it to remain. The quantity is sometimes enormous, 
ranging between thirty-five and ninety-six quarts. After the 
quantity desired has been obtained, the canula of the trocar is 
carefully withdrawn, and a bandage or roller of adhesive plaster 
placed around the body of the animal. 

Among accidents possible in this operation, wounds of blood- 
vessels or of the intestines, and fatal peritonitis may be men- 
tioned. 

HEENIA. 

General View. 

In a general sense, any tumor formed by the entire or partial 
escape and protrusion of an organ, either wholly or in part, from 
the restraining tension of the integuments, or from the cavity 
which forms its normal location, is a hernia, or in popular phrase, 
a rupture. The more special appUcation of the term is to the dis- 
placement of the abdominal viscera, but it is also employed to 
describe the encephalocele, or protrusion of the braia through the 
cranium; the projection of the iris and the ^'aJoi, or protrusion of 
the oesophagal mucous membrane, through its muscular coverings. 
And again the prominence of a synovial membrane beyond its 
ordinary bounderies: that of a muscle through its aponeurotic 
envelope ; the prolapsus of the rectum ; of the vagina ; of the 
uterus, etc., etc., — these also receive the same designation and are 
recognized members of the hernia family. We shall, in the pres- 
ent chapter, mainly limit our consideration to the displacements of 
the abdominal digestive organs. 

The rationale of the formation of a hernia becomes a matter 
of easy comprehension, when we take into consideration the gen- 
eral anatomy of the abdomen, and especially the structure of its 
inferior wall. The muscvdar layers which form the exterior wall 
of this large splanchnic cavity are not of equal density through 
their whole extent, and consequently do not offer in every part an 
equal amount of resistance to the outward pressure of the interior 



386 



OPERATIONS ON THE DIGESTIVE APPAEATUS. 



contents. In one place musciilo-cartilaginous, or bony, it is in 
another, musculo-aponeurotic. In some parts jorotected by only a 
single layer of muscle, as in its anterior wall ; in others the layers 
of muscular aponeurotic structure, or of fibrous bandages, are re- 
inforced by a powerful elastic band, as in the inferior portion, by 
the tunica abdominahs. But besides this variety in the elements 




Fig. 372.— Muscles of the Inferior Abdominal Region. 



1, aponeurosis of the great ohlique; 2, fleshy portion ol the small ohlique; 3, straight of 
the abdomen; 3 ', transverse of the abdomen; 4, pre-pubic tendon; 5, inguinal ring; 6, its 
anterior border ; 7, the posterior ; 8, external commissure ; 9, internal commissure ; 
10, posterior border of the aponeurosis of the great oblique ; 11, internal crural aponeu- 
rosis; 12, flap of the aponeurosis of the great oblique, drawn downward to show the 
origin of the reflex portion which forms the crural arch ; 14, remains of the umbilicus. 

forming the walls of the cavity, there is also to be taken into con- 
sideration the fact that, at certain points in the walls, natural 
openings exist, and that the abdominal cavity is therefore not 
strictly a close cavity. These passages consist of the inguino-cru- 
ral openings, the umbilicus and those found in the diaphragm for 



HERNIA. 387 

the egress of certain organs out of the abdomen, either during 
foetal hfe or after birth. 

The hernia, when not arising from a traumatic cause, is the 
result of some violent muscular effort on the part of the animal, 
in the coui'se of which the viscera are made to exert a violent out- 
ward pressure upon the walls of the abdomen. If the pressure 
bears against any of the more soHd portions of the wall, there will 
be no yielding, and the parts will remain iininjured and intact. 
But if the pressm'e becomes unduly violent, and the attack is di- 
rected against some one of the weaker supports, there must be a 
jdelding, and the intestine or omentum, as the case may be, will 
be forced through the opening which falls most nearly in hne with 
the direction of the violence. The resistance fails, the viscera 
passes through the aperture, and there is a protrusion, a rup- 
tui'e, a hernia. 

Two elements must enter into the composition of all hernias, 
with the exception of eventrations. They are the sac, and the 
displaced organs which form its contents, and the mode of its 
formation may be readily comprehended by a consideration of the 
figures 373, 374, 375, which show the progressive displacement of 
the peritoneum, as it is pushed through the opening of the ab- 
dominal waUs, by pressure of the intestines, which are also gradu- 
ally passing through the same opening. The figures show in what 
manner the hernial or 2^eritoneal sac is formed. 

The sac is thus shown to be the j)i'olongation of the perito- 
neum, which is displaced, moved and distended, or may have sus- 
tained partial laceration of its fibres. It may even happen that 
the rupture of that serous membrane is complete, and that it has 
become lodged in the cellular tissue. In such a case the lacerated 
peritoneum soon throws out a provisional reparatory sheath, which 
becomes continuous with the natural serous membrane. 

Whether formed by the peritoneum itself, or by a membrane of 
secondary formation, the sac is always composed of a middle por- 
tion, or body, and an opening, or ring, which constitutes a means 
of communication with the abdominal cavity, with a neck or canal, 
a narrowed portion, uniting together the body and the opening of 
the tumor. 

But Uttle uniformity exists in the formation of the ring or 
opening of a hernia. In some instances it is rovmd or oblong, in 
others it is a narrow slit, and again it exhibits a triangular outline. 



388 



OPERATIONS ON THE DIGESTIVE APPARATUS. 




Fig. 373. 




EXPLAKATION.— In these three 
flgures an idea of the mode of 
formation of hernias is given: 
aa aa aa, represent a section of 
the abdominal wall; o o o, the 
aponeurotic opening through 
which the peritoneum, pppppp, 
is engaged to form the hernial 
sac, s; the intestine, ii ii it, is 
shown entering the hernial sac 
gradually. 



Fig. 374. 




Fig. 375. 

In the ventral kind the aperture is wide and of varying dimen- 
sions, and it may, moreover, be quite wanting, or again, it may 
be long and cylindrical, as in inguinal rupture; while in the um 
bilical variety it is very short, and represented merely by the 
thickness of the edges of the hernial ring. The body or middle 
portion of the intestines, or that which becomes lodged in the 
cavity of the sac, also varies in size, direction and form, and may 
be considered imder the four principal heads of the cylindrical. 



HEKNIA. 



389 





Fig. 376.— Cylindrical Hernial Sac. 



Fig. 377.— Spheroidal Hernial Sac. 





Fig. 378.— Conical 
Hernial Sac. 




Fig. 379.— Pyriform Fig. 380. -Hernial Sac 
Hernial Sac. in Clusters, or having 

three contractions— 
/, d, b. 




Figs. 381, 382 — Multilobular Hernial Sacs. 



390 OPERATIONS ON THE DIGESTIVE APPARATUS. 

the spheroidal, the convex^ the pyriform, to which Zundel adds 
the clustered and the vnxdtilohular . 

The relation as to dimensions between the body of the hernia 
and the measurement of the ring is a point of importance in re- 
lation to estimating the more or less serious nature of a case. It 
will readily be inferred that with a narrow and contracted open- 
ing, an obstruction may easily take place, and at an early date, 
and that in due time the result will be manifested in the legitimate 
form of a strangidation, an accident which will be accompanied 
with various phenomena, according to the degree of pressure and 
the duration of the period of formation, and all of them attended 
with trouble and danger. 

At first, as the capillary circulation becomes retarded and diffi- 
cult, the intestines assume a red color, which passes successively 
through many shades, from deep red to brown or a blue-black, 
indicating the arrest of the blood, of which the dreaded sequel 
may be looked for in the appearance, a httle later, of signs of mor- 
tification of the parts involved. 

The blood then transudes through the walls of its vessels, and 
filtrates into the sub-serous and sub-mucous cellular tissue, thus 
increasing the bulk of the contents of the sac. At the same time 
the external surface of the protruding intestines becomes the seat 
of what is at first a yellowish exudation, but which becomes a 
bloody deposit, ready for organization if the patient lives long 
enough to survive the pains of the strangulation. By the eight- 
eenth or towards the twenty-fourth hour, however, signs of total 
gangrene make their appearance and the hernial portion becomes 
flabby, cool, and insensible; the odor becomes very offensive, and 
the tissues easily lacerated or torn. The fatal end is then near, 
being rarely deferred beyond the twenty-fourth hour, unless im- 
mediate relief has been interposed. 

But, of course, every case does not observe this regvilar succes- 
sion of symptoms, nor reach the same final termination, and in 
the instances in which the interference with the circulation is less 
pronounced and the degree of pressure upon the protruding 
organ is lighter, probably not more than sufficient to interfere 
moderately with the movement of the intestinal contents, we have 
a modified evil to contend with in the obstruction or engorgement 
of the hernia, with consequences in view less discouraging to con- 
template The exudation upon the surface of the contents of the 



HEENIA. 

p/'f fi/////r////W /// Ilium 



391 




Fig. 383.— Strangulated Inguinal Hernia. 
A, intestinal circumvolution. B, herniated portion of the intestine. D D, neck of 
the vaginal sac compressing the intestines. E, internal wall of the vaginal sac. T, tes- 
ticle in the fundus of the vaginal sac. 

sac has resiilted in an adhesion with the internal surface, and the 
hernia has taken its place in the class of the irreducible. Hernias 
of long standing-, which have, at intervals, shown indications of 
obstructions, are, in the greater number of instances, in fact, ir- 
reducible 

There are still, however, cases of simpler condition in which 
the viscera continue to be movable in the sac, in which fact they 
are due to the lubricating effect of a free serous exudation. 



392 OPEKATIONS ON THE DIGESTIVE APPAKATUS. 

Aside from other distinguisliing characteristics, all hernias are 
divisible iato two classes — internal and external. Of the latter, 
some, as the eventration, have no containing sac, while the others, 
which have a serous covering, are in reahty alone entitled to be 
considered as the true hernias. These, usually occurring through 
one of the natural openings, are called natural, in opposition to 
the accidental, which, like the ventral hernias and the eventration, 
occur through accidental and artificial openings. Any of the ab- 
dominal viscera, with the exception of the pancreas and the kid- 
neys, may enter into the formation of a hernia, and as each is 
known by the name of the displaced organ, we are given the 
designations of enterocele for a hernia of the small intestines ; epi- 
plocele, for that of the omentum, and enter o-epiplocele of both the 
intestines and omentum. • The name of gastro-ventral is given to 
the ventral hernia which involves with it the stomach ; cystocele, 
when it is the bladder which is affected, and hysterocele when the 
uterus is concerned. Hernias can be, moreover, congenital or oc- 
casional — that is, they may exist at birth or previous to it, and 
also when making their appearance under special causes after 
birth. They may be also considered as acute when recent, or 
chronic, when of long standing. 

Their originating causes are numerous, and may be said to 
comprehend any which may predispose an animal to such a lesion 
by contributing to an increase of the pressure which the organs 
contained in the abdominal cavity bring to bear upon its walls, or 
any weakness in the walls, which may diminish their power of re- 
sistance to the pressure, as, for example, a condition of leanness 
arising from a sudden or recent change from a state of obesity ; 
blows upon the abdomen ; wounds and cicatrices of the abdomi- 
nal walls ; violent, jerking efforts, such as those required in com- 
pulsory jumping or hauling, or in any other of the struggles to 
which they are too often forced, and even when under the sur- 
geon's hands, when, as a patient, the animal is cast and secured 
for an operation; the rapid relaxation after contraction of the 
natural openings, repeated pressure, or excessive dilatation, as 
with stallions used for covering mares, may be placed among the 
predisposing causes. They have also been observed in mares, 
after violent efforts during parturition ; also during colics and 
other tympanitis. To recapitulate and partly to repeat 

The general symptoms characteristic of hernias, are compar- 



HERNIA. 393 

atively easy to recognize, and can be reduced to two principal 
points, to wit — the discovery of a tumor, and appearance of an 
opening coexisting in the abdominal waUs. These tumors and 
openings offer many varieties of form and character. The tumor 
located opposite to a natural opening, or under a breach or separ- 
ration in the structiu'e of the abdominal walls, or under a cicatrix, 
forms a mass, indolent, elastic, remittent, of varying size, but di- 
minishing or increasing under peculiar conditions, such as rest or 
pressure, and the standing, or the lateral or recumbent position, 
etc., and having different forms, being located in various places. 

It has also, in many instances, the quality of being reducible, 
that is, it may be made to disappear by means of certain manipu- 
lations and appropriate treatment, and arrangements of position, 
to return to their previous status when these agencies are sus- 
pended ; or again, they wiU. become permanently irreducible under 
special pathological changes already alluded to. The presence of 
borborygmus is also an important item among the means of form- 
ing a physical diagnosis of these tumors. This is detected more 
or less readily when the displaced organ is a portion of the in- 
testines. They are, however, missing when the hernia is formed 
by other organs, as, for instance, in case of epiplocele. Other 
points connected with this subject remain to be mentioned. 
Among these are the final symptoms, and more or less remote re- 
sidts, which may follow the presence and working of the lesion 
upon the general economy and the physiological functions at 
large, when the acute action has passed away. 

The constitutional symptoms, or what may be so denominated, 
will vary, in their nature and their intensity, correspondingly with 
the condition of the hernia and the comphcations which may ac- 
company each case. Among these comphcations, four principal 
ones may be mentioned as taking precedence : 

1st. Irreducibility. — This is more frequent in old cases than 
in new, and is probably due to the increase in size of the dis- 
placed organ to the degeneration of the tissues, or to old adhe- 
sions between the organ and its covering, the sac. These cases, 
which may be considered rather permanent than merely chronic, 
maintain their status, either completely or partially, unchanged. 
Yet they cannot, naturally or rationally, be held to be compatible 
with a sound constitution or unimpaired stamina in the animals 
so conditioned, and their Habihty to contract indispositions easily 



394 OPERATIONS ON THE DIGESTIVE APPARATUS. 

has frequently been remarked. Difficulty in the performance of 
movements requiring effort has also been noticed, with conse- 
quently a liability to suffer traumatic injuries from external vio- 
lence. To this must be added a facihty in contracting: 

2d. Injimn'tnation. — Generally this occurs as the I'esult of 
external injuries, but it may also occur without any apparent 
cause. Its seat is the sac or its contents, and it affects the serous 
structures alone, or assumes a phlegmonous aspect. The inflam- 
mation of the serous tissue is often overlooked, while that of the 
phlegmonous cannot pass unobserved. It may sometimes assume 
a very serious character, and become even more dangerous than 
the true strangulation. 

3d. Ohstructions or engorgements, common in intestinal her- 
nias, are due to the accumulation of alimentary or stercoraceous 
masses in the displaced intestines, or to gases which interfere 
with the reduction of the hernia. This is often complicated with 
strangulation, but is not in itself of a very dangerous nature. 

4th. Sitr angulation. — This condition has been already consid- 
ered. It is the result of excessive pressure upon the blood 
vessels of the displaced organ, and while under its three periods 
or degrees of congestion, inflammation, and gangrene, has usually 
a fatal termination. 

The general treatment of hernia has the two objects in view of 
the destruction or obliteration of the sac, and the reduction or 
closing of the ring. If the first is not always easy to accompHsh 
the reduction of the diameter of the ring often is so. Each form 
of hernia demands some special directions for the reahzation of 
these two objects, and these will each receive its own share of 
attention as they may in turn come under our notice in further 
treating the various forms of hernia. 

Inguinal Hernia. 
Inguinal hernia results from the passage or presence of a 
portion of the intestines, or of the omentum, or of both together, 
in the testicular or vaginal cavity whose opening of communica- 
tion with the peritoneum or inguinal ring continues in its normal 
condition, having never closed. A brief survey of the general 
anatomy of the region involved will be a necessary preliminary to 
our discussion of the subject, which is one of interest and im- 
portance. 



395 



OK O K o 

\] II fit "I' fif iJii'ih Jii ii\ 




Fig 38 1.— Anatomical Disposition of the Inferior Inguinal Ring and Testicular Sac. 

Explanation of Fig. 384.— A C, testicular sac, in which are shown— list, the neck 
situated above- the letter A, and concealed in the inguinal canal; 2d, a middle portion 
extending from A to E ; 3d, a fundus, B C, where the testicle is. D D, division of the 
scrotal artery. F G, inferior inguinal ring, whoso internal commissure Is rounded 
and formed of white fibres crossing each other and attached to the prepubic tendon. 
H H, fleshy portion, from the small oblique, and forming the anterior and internal lip 
of the inguinal ring. K K, postero internal edge of the inguinal ring, formed princi- 
pally by an aponeurotic portion of the great oblique. L, scrotal artery. M, veins of 
the scrotum and of the penis. N, part of the penis thrown backward, o o o, tunica 
abdominalis. P, muscles of the flat of the thigh, short adductor of the thigh. 

The inguinal canal is an infundibuliform cavity, flattened 
from one side to the other. It is situated in the groin, and 



396 OPERATIONS ON THE DIGESTITE APPARATUS. 

through it pass the testicular cord and the testicvilar blood ves- 
sels, in the male, and the blood vessels of the mammae in the 
female, as they emerge from the abdominal cavity. Situated on 
one side of the prepubic region, it observes an oblique dii'ection, 
downward, backward, and from without inward, being formed 
posteriorly by the crural arch, and anteriorly by the fleshy portion 
of the smaU oblique muscle of the abdomen. Inferiorly it has 
an opening called the inferior inguinal ring, which is made 
through the aponeurosis of the great obUque, oval in shape, and 
possessing two lips, edges or pillars, united together by two 
commissures. The lips, divided into anterior and posterior, are 
formed by the fibres of the aponeurosis of the great oblique 
muscle of the abdomen, and a few of the muscular fibres of the 
small oblique, reinforced by some bands of the tunica abdominalis. 
The commissures, divided into external and internal, result from 
the union of the extremities of the two pillars. The superior 
opening of the inguinal canal is known also as the peritoneal 
or superior inguinal ring, and is situated in front of and directly 
opposite the crural ring. It represents a single slit, subject to 
dilatation, placed also between the crural arch and the small 
oblique of the abdomen, and allowing on its inner border the pas- 
sage of the anterior pudic or posterior abdominal artery, it sur- 
rounds the neck, and forms the entrance of the vaginal sheath. It 
is open in horses, and often in bovines also, and it allows a direct 
communication between the cavity of the vaginal sac and that of 
the peritoneum — undoubtedly a predisposing condition to hernias, 
not to be overlooked. The testicular sac off'ers to our attention, 
from the point of view from which we now consider it, an 
entrance, or true infundibulum, overlapping the internal opening 
of the inguinal ring or canal; a neck situated just below that ring, 
a continuation of the infimdibulum or entrance, and which at a 
short distance from its origin offers a well marked contraction in 
its diameter — this being the point where strangulation takes 
place — a tnicldle part, containing the spermatic cord; and a 
bottom, or true cvd-de-sac, where the testicles and the epididjTuis 
are lodged. 

The special signification of the terms which have been else- 
where and already employed to designate and classify the varie- 
ties of form and manifestation characterizing difi'erent varieties of 
hernia are of interest, and should not be lost sight of. They are 



HERNIA. 397 

divided principally into recent or acute, and old or chronic, and 
we find them considered as enter ocele, epiplocele, and enter o- 
eplplocele, according to their contents. The name of vaginal 
hernia has been used to denote a case in -which the intestine is 
directly engaged in the inguinal canal; and hernia of the ring, or 
hernia in the canal, describes that in which the viscera have en- 
tered but a short distance into the sheath. Bubonocele signifies 
that the intestine has entered but a very slight distance into the 
inguinal sheath, in opposition to the oscheocele or scrotal hernia, 
when the intestine falls quite down into the sac, and with the 
testicles themselves, occupies the bottom of the scrotum. 

Inguinal hernias are generally accidental, but, as some authors 
hold, are also sometimes congenital, having been found existing 
at birth ; and in many instances they become permanent, the in- 
testines occupying the vaginal sac without change, as a fixity. 
Then, again, they may be intermittent, disappearing more or less 
completely, under peculiar conditions, only to reappear imder the 
stress of new influential causes. Of coiu'se the classification of re- 
ducible and irreducible, always holds. The classification of the 
hernia of castration, which takes place during or after that operar- 
tion, is considered by some to be properly one of the forms of 
eventration. 

A consideration of the anatomical disposition of the vaginal 
canal, and especially of its upper ring, which presents an opening 
communicating with the peritoneal cavity, will explain the reason 
why inguinal hernias of the horse are more common in the stallion 
than in the gelding. It is rare in bovines, but Lafosse has seen 
it in sheep and in rams and although the anatomical disposition 
of the canal in the dog render its occurrence difficult, Wolstein 
has observed it in that animal. Cases are rare in females, but 
Girard, Jr., has seen it in mares, Rychner in cows, and Hering, 
Hertwig and Goubaux in bitches. 

Recent Ingtjinal Hernia. 
^Tien the hernia appears suddenly, in a subject not j^redis- 
posed to it, the first symptoms are those of abdominal j)ain, ap- 
pearing suddenly and without warning, and quite inconsistent 
with the general perfect health of the animal. These symptoms 
are at first vague in their significance, and definable merely as ex- 
hibitions of simple pain in the abdomen. 



398 OPERATIONS ON THE DIGESTIVE APPARATUS. 

If in the stable, the animal becomes restless, paws with his 
fore feet, gazes earnestly toward his flanks, and flexes his legs, 
as if to he down, and perhaps accomplishes that movement, but 
only to resume the standing position. The skin is moist, the per- 
spiration appearing on the face, around the ears, behind the 
shoulders and in the groins. If he is in harness, his action is 
changed, he shortens his steps, stops pulling, wants to stand still, 
and becomes covered with abundant perspiration running over 
him and drijDjDing from his belly. These first symptoms excite 
suspicion as to the real cause of the trouble, but they soon assume 
a character which changes the suspicion into certainty. They rap- 
idly assume greater severity, increasing in the ratio of the suffer- 
ings of the animal, which then has no more rest or intermission, 
and gives evidence of the most intense abdominal pain. He paws 
and stamps upon the floor more and more violently, sometimes 
kicking his abdomen; gazes anxiously toward his flanks; lies 
carefully down and rolls to and fro on his back, sometimes 
keeping the dorsal position for a few moments, as if he could 
only thus find relief; then suddenly rises to his feet and rej)eats 
the movements, which give evidence of the torture he suifers, but 
more forcibly and rapidly than before. The expression of his 
face soon becomes characteristic. The lips are contracted, the 
nostrils are retracted and dilated, and the widely opened eyes ap- 
pear unnatiu'ally large and prominent, rendering their agonized 
expression more and more striking. The respiration becomes ac- 
celerated and the pulse more rapid; the perspiration streams 
more copiously from his body and the poor animal groans under 
the weight of his trouble. 

After a lapse of some hours, the time arrives for the occurrence 
of strangulation, which may be pronounced the crisis or fatal 
event of inguinal hernia. It is characterized by a peculiar mo- 
tion of the head, which is thrown up and down repeatedly (and 
which the French have designated by the word " encensd.'') This 
motion, which is sometimes habitual with horses while in harness, 
has a pecuHar meaning when it becomes the expression of the 
coHc of hernia. It is then performed slowly, the head being ele- 
vated gradually and extended upon the neck, to be suddenly 
dropped again as if from weakness, to be again raised and 
dropped during the few and brief intervals of remission of the 
pains, while the animal possesses the ability to keep on his feet. 



HERNIA. 399 

In fact, when the hernia is completed, the coHcs are so violent that 
the animal no longer lies down, but literally throws himself with 
violence upon the ground, having become forgetfvd of the natural 
instinct of conservation, and now rendered indifferent to all other 
pain by the overpowering force of the hernial torture. With his 
body covered with bruises, and bleeding from numerous superfi- 
cial wounds, he now becomes a pitiable object. There are animals 
of particularly sensitive temperament which will even, Hke those 
in a rabid f m-or, bite themselves on their flanks and forearms in 
their delirious desperation. 

Diiring these excessive sufferings there seem to be just two 
positions in which the animal can experience a comparative de- 
gree of comfort. They are, lying on his back, or maintaining the 
dog-sitting posture, on his haunches. But these movements of 
reprieve are of but short duration, and the pains may continue to 
be manifested without cessation, by tumultuous, violent, imequal 
struggles, which may continue twelve or fifteen hours, or even 
more. At last, toward from the fifteenth to the twentieth hour, 
all the signs of pain subside, and a great calm succeeds to the 
previous violent agitation. This, however, is far from being a 
good sign, or an indication of the termination of the disease. It 
is, on the contrary, a sure token that a fatal termination is close 
at hand, and if the patient has ceased to suffer, it is because the 
anesthesia of death has fallen upon the organ in which his pains 
originated. The parts which were so recently altogether too much 
alive, have died. Gangrene has attacked the imprisoned intestine, 
and with its apjDearance, loss of feeling has also come — and death 
— for death is the loss of feeling. The animal is now in a con- 
dition of extreme prostration. The temperature is diminished; 
the perspiration is cold, the pulse is imperceptible, his face is 
without expression, the poor brute can scarcely maintain a stand- 
ing posture or move his legs when urged to stir, and when the 
last remnant of his strength is exhausted, after a few hours, he 
drops upon the earth and dies without a struggle. Death rarely 
delays beyond twenty-four hours following the strangulation. 
This is the extreme limit, and in the greatest number of cases it 
takes place within a shorter period. 

These manifestations (the description of which we borrow from 
H Bouley), constitute the series of general symptoms of hernia, 
but, at the same time, they do not belong exclusively to that kind 



400 OPERATIONS ON THE DIGESTIVE APPARATUS. 

of injury. They are those of any violent abdominal pain spring- 
ing from any cause, and may be met with in invaginations, volvulus, 
intestinal obstruction, etc. But if not possessing any positive and 
intrinsic significance in themselves, they assume great value in the 
diagnosis, when added to the series of local, or pathognomic symp- 
toms which have their origin and limit in the inguinal region. 

Two methods are available for the location of the seat of 
the lesion, one being the external exploration of the inguino- 
scrotal parts, the other consisting in the internal rectal examin- 
ation of the pubic region. In a horse, and especially a stallion, 
suffering from colics, the indication to a general and immediate 
examination of the inguinal region, for abnormal appearances, is 
always present, and it will not be safe to be too easily satisfied 
with visual examination exclusively, to become certain that no 
part of the intestines is engaged in the vaginal sac. The eye 
may be deceived; it is the touch alone which will prevent all 
possibility of error. The sensation imparted to the touch at the 
beginning of a recent inguinal hernia is that of a thickened testi- 
cular cord which has lost its usual suppleness, and whose con- 
stituents can no longer be determined under the pressure of the 
fingers. Thus thickened, the cord gives a sensation of resistency, 
increasing as the exploration is carried further up in the groin, 
while toward the bottom of the sac, the scrotal mass feels fuller 
than usual, the testicle becoming less movable, giving the sensa- 
tion of a slightly puffy tumor. After several hours duration of the 
disease, the characters become better marked, in consequence of 
the increase in the size of the intestine, and the amount of exu- 
dation, and there is also a formation of gases above the neck of 
the sac, which also contributes to its increase in size. 

The hernial tumor has thus become changed from its original 
appearance, by its enlarged size, and is easily detected by the great 
general tension caused by the presence of the accumulating gases ; 
the cord is found to be tumefied in its whole length, while its 
renitentcy increases as it extends upward into the canal. Direct 
pressure with the fingers upon the tumor does not seem to cause 
great pain, probably because this local sensation is dulled by the 
extension of the excessive pains which radiate from the hernia 
throughout the entire abdominal system. The external characters 
of the inguinal tumor become more noticeable when both sides of 
the testicular regions are compared, the difference between the 



HEKNIA. 401 

healthy and the diseased regions being then easily ascertained. 
Continued spasmodic movements of the healthy testicles have 
been observed. 

In the rectal examination of the horse, the hand may be easily 
carried beyond the anterior border of the pubis, and the condition 
of the superior ojDening of the inguinal canal, and the state of the 
organs engaged in it thus ascertained. 

In the normal condition, the anterior pillar of the superior 
opening of the canal is easy of identification. It is in front and 
on each side of the pubic region, and by reason of the extensi- 
bility of its muscular structure, requires no greater force for its 
separation from the posterior pillar than the introduction of two 
fingers into the ring. When the intestine is in the vaginal canal, 
after having passed through the superior opening, it can be felt 
with the hand through the walls of the rectum, its situation being 
generally on the inner side ; and being thus recognized, it can be 
raised, pulled upon, and sometimes even extracted from the open- 
ing through which it had passed. But to be able to judge accu- 
rately the nature of the object which has been felt, requii'es in 
the siirgeon an amount of experience in the taxis not always pos- 
sessed, while its absence may at times betray the explorer into 
serious error. Moreover, the sensations transmitted through the 
rectum cannot in every case be triily interpreted, and it sometimes 
becomes necessaiy to combine the two modes of examination em- 
ployed simvdtaneously — the rectal investigation and the external, 
manual, testicular exploration. 

Thus, when with one hand in the rectum, pressing on the in- 
ternal ring, and the other pushed well into the depths of the in- 
guinal region, both are brought in contact, and it is discovered by 
the actual touch that the inguinal canal is cleai*, the hypothesis 
of strangulated hernia is at once negatived. 

On the other hand, if there is hernia, and the imprisoned intes- 
tine is encountered, the fingers of the two hands cannot possibly 
come in contact, and the next question will be one of indication, 
if not of prognosis. 

As a rule, the prognosis of recent inguinal hernia is always seri- 
ous. If developed without organic predisposition it is necessarily 
a serious lesion by reason of its tendency to spontaneous strangu- 
lation,, which when unreHeved means death by torture, unless the 
fatal event should be humanely anticipated and prevented by the 



402 OPERATIONS ON THE DIGESTIVE APPARATUS. 

fiat of a compassionate master. But a fatal prognosis need not 
be unnecessarily volunteered. Timely and vigorous measures, es- 
pecially emphasizing the "timely," may still prevent the strangu- 
lation and defer the sentence of mortality, and the sooner, there- 
fore, the means of reHef are applied, the more certain will be their 
effect. Every minute's delay increases the force of the disease and 
lessens the chances of success. It is rarely the case that the lapse 
of fifteen hours leaves any room for confidence, though it is not 
yet time to abandon hope. Within that period there are many 
chances for saving the patient, but after the earlier periods of the 
attack a single hour's neglect may be fatal — that hour may prove 
to be the turning-point of the conflict. 

The treatment of recent inguinal hernia assumes two forms, 
consisting of the taxis, and the oj)eration of herniotomy, or the en- 
largement of the neck of the vaginal sheath with a cutting instru- 
ment. The first mode is indicated at once, or as soon as the her- 
nia is recognized. The reduction must be accomplished in the 
shortest time possible, the danger of strangulation becoming more 
imminent and threatening with the lapse of every moment. The 
taxis may give immediate relief, and may be materially assisted by 
douches of cold water. 

In this case the taxis consists in the manipulation of the part 
with the hands, by pressure and otherwise, for the purpose of re- 
placing the protruding intestine in its proper cavity ; technically, 
the reduction of the hernia. This manipulation is appHed either 
by simple pressure over the external surface of the diseased part, 
or, if practicable and necessary, by supplementing it with a proper 
traction appHed upon the intestine from within through the rectal 
walls. This manipulation may be applied by two processes, first 
the subcutaneous, medial or indirect^ and second, the direct taxis. 

1st. The Indirect Taxis. — In the first or indirect method, the 
animal is placed in a standing position, with the hind legs secured. 
Then the hand and arm of the operator, well oiled, are introduced 
into the rectum, using the right, if he is to operate on the left side, 
and vice versa. "When in the rectal cavity, the hand is carried to 
the anterior border of the pubis, while with the other, passed in 
front of the patella, pressure is applied upon the scrotal sac, and 
the intestine pushed toward the superior opening. The hand in 
the rectum then grasps the loops of the hernia, through the rectal 
walls, and at the same time pulls them ujDward. Through these 



HERNIA. 403 

manipulations the surgeon may succeed in removing the difficulty, 
if by that time the testiciilar sheath continues to be free from con- 
gestion. But if this akeady exists, and the coUcs are increasing 
in severity, the taxis in the standing position becomes impossible 
and it wiU. be necessary to throw the animal. This done, he must 
be placed in the dorsal position, with his hind legs kept apart and 
his haunches raised as much as possible by bimches of straw. 

In this position, the operator must proceed to practice what 
must be described as an exceedingly dehcate massage or taxis 
uj)on the scrotal sac, both hands being used, in such a manner as 
to crowd or press the intestinal mass toward the superior opening 
of the canal. The design of this is to stimulate the circulation 
through the capillaries, and also to free the cavity of the intestine 
from the semi-fluid and gaseous contents which ma}' be present, 
by this means diminishing its volume and facilitating its reduction. 

That this must be done with the utmost caution and jDatience, 
needs hardly to be urged. And it should be persevered in for at 
least a period of thirty seconds before advancing to the other 
step, which consists in gradually pushing the intestine toward 
the opening. If the protrvidmg loop is not too long, and the 
massage has succeeded in its design, and the bulk of the tumor 
has been sufi&cieutly diminished, and, above all, if the hernia has 
had but a short existence, it may be within the probabihties that 
this external taxis alone will be sufficient to reduce it. But such a 
result cannot be counted on with any degree of certainty, and it 
is then the simple dictate of wisdom to make assurance sure, if 
possible, by having recourse to double taxis, and attacking the 
danger at both its internal and external accessible points. 

For a single operator to undertake the performance of both 
branches of this compound manipulation can hardly be advised. 
Few men possess the necessary powers of endurance, and an acci- 
dent might easily compromise the very life of both surgeon and 
patient. At the least, it involves quite an unnecessary amount of 
effort and fatigue. All the reasons are in favor of a di\dsion of 
the work, by which a competent assistant will be put in charge 
of the rectal taxis portion of the labor, while the practitioner in 
chief will direct and execute all the other steps of the treatment. 

The successful result of the operation will be known at once 
by the diminution of the tumor, the disappearance of its puffy 
and tense condition, by the sudden sensation of yielding, felt by 



404 OPERATIONS ON THE DIGESTIVE APPARATUS. 

the hand working in the rectum, and also by the facility with 
which the fingers of that hand can be introduced into the now 
liberated superior ring. 

Anesthetics have been recommended as powerful adjuncts in 
the application of the taxis, in this class of cases. Bouley 
recommended their use, and Bagge, a Russian veterinarian, 
agrees with Bouley, in advising their administration. His pro- 
ceeding is thus described : The rectum being emptied, a solution 
of two to four grammes of chloral and sixty or seventy centi- 
grammes of acetate of morjjhia are thrown into it, while at the 
same time compresses of chloroform are laid on the diseased side 
of the inguinal region. In the course of ten minutes there is 
such a relaxation of all the tissues that the reduction by rectal 
taxis is quite easy. The spermatic cords are then surrounded by 
rolls of bandages moderately tight, in order to prevent the return 
of the hernia. These bandages are left on for eight or ten hours. 
The danger of strangulation upon the testicular cords is an im- 
portant objection to the adoption of this process. Severe appli- 
cations of douches of cold water applied for one or two hours 
previous to the taxis have been successfully employed by Steff 
and Lacassin. 

A process known as that of Patey, from its discoverer, con- 
sists in the injection of oil of belladonna into the hernial sac, the 
action of the oil, it is claimed, producing the dilation of the 
pseudo-sphincter, which prevents the reduction. It causes a cer- 
tain flaccidity of the parts, renders the taxis much easier, and con 
siderably facilitates the reduction. 

2d. The Direct Taxis. — This procedure is of too dangerous a 
character to mamtain a place in the domain of veterinary surgery, 
except under very exceptional conditions. It consists in apply- 
ing the manipulations of the taxis directly upon the intestine, 
previously exposed by the dissection of the testicular envelopes. 
These manipulations, which are dangerous when the intestine is 
distended by gases or fluids, may, however, be rendered easier by 
relieving the intestinal loop, through the use of a fine needle- 
trocar or aspirator, of the cause of its abnormal dilatation. 

The method of Renault, mentioned by Zundel, is also a form 
of direct taxis which, though it may be employed in cattle, involves 
a subsequent fatal peritonitis in the horse. The operation con- 
sists in the opening of the flank and the performance of the re- 



HEKNIA. 405 

duction by dii'ect traction with the hand thus introduced into the 
abdomen. 

The operation of herniotomy is that which consists in the 
section of the neck of the vaginal canity. It is the proper opera- 
tion ioY strangulated hernia. Bouley has said: "This operation 
is not, as one may be inclined to think, a last resource, which is 
not to be used except after the taxis, under its various forms, has 
been appHed and failed. Far from it. We beUeve, on the con- 
traiy, that in the horse, the taxis is a means of treatment which 
is trvdy indicated only in the first five or six hours of the descent 
of the intestine ; that even, in this first period of time, one must 
not use it too much nor too long, from fear of the compHcatious 
which might arise through the rectal manipulations, and that 
after this Hmit of a few hours has elapsed, it is better to have re- 
course immediately to the operation, without trusting to vain 
hopes from the use of the taxis." The operation is comparative- 
ly a simple one, the dangers which were formerly apprehended 
having been greatly reduced by a better knowledge of the seat of 
the strangulation, and of the parts to be divided, and the ratio of 
mortahty is now so small — forty-two recoveries out of fifty-two 
operations — that hesitation is no longer justifiable. 

The instruments requu'ed for this operation are straight and 
curved bistouries, scissors, an ordinary director, a herniotome 
(Figs. 3846i!, 385), or blunt, straight bistoury, and a pair of curved 
clamps with strong cords to secure their branches. The hernio- 
tome is a histoury-cacJu, which, however, since the use of general 
anesthesia, has been replaced by the blunt, straight bistoury, en- 
ables the operator to diride the neck of the vaginal sheat*h in the 
right place with more certainty than heretofore, and to regulate 
more accurately the dimensions necessary to relieve the strangu- 
lation. The director which is best adapted for use in herniotomy 
is one which has a flat, lanceolated, grooved surface at one end, 
and which, while it guides the blade of the bistom-y, contributes 
likewise to the protection of the intestine against the possibility 
of injury by the shai-p edges of the bistoury. 

The patient to be operated on is laid upon a soft bed, anes- 
thised as completely as possible, and placed ujDon his back. The 
hind leg corresponding to the side where the hernia is located is 
freed from the hobble, secured with a rope, and carried outward 
in abduction, with the rope made fast to a fixed point near by — 



406 



OPEBATIONS ON THE DIGESTIVE APPARATUS. 



Fig. 384a. 
Herniotome. 



Fig. 385. 
HerniotomeB of Colin, 



as a ring in the wall, a post, a tree, or 
other immovable object. If the oi:)era- 
tion is to be performed at night, which 
is too often necessarily the case, the 
presence of additional assistants will 
probably be required, in order to insure 
an abundant amount and proper man. 
agement of light, which is indispensable 
in so delicate a dissection. 

In operating, the surgeon kneels be- 
hind the patient and with a curved bis- 
toury begins by making a long incision 
upon the tumor, parallel with the long 
axis of the testicle. 

This incision is similar to that which 
is made in castration with covered testi- 
cles, and must involve onl}- 
the scrotum, the dartos, 
and the first layers of the 
lamellated cellular tissue 
which unite this last to the 
tunica erythroidea. The 
remaining portion of this 
lamellae is then carefully 
incised, until the fibrous 
coat is exposed, and the 
tumor is entirely enuclea- 
ted from its envelope of 
cellular tissue. This done, 
the fibres of the tunica 
erythroidea are scraped 
apart with the point of the 
straight bistoury, until the 
vaginal sac has been open- 
ed, which the operator dis- 
covers by the appearance 
of a stream of liquid pass- 
ing through. The canula- 
ted director is then intro- 
duced into the opening and 




HERNIA. 407 

guides the bistoury, with which the hernial sac is now freely 
opened, in front and behind. This free cutting allows the escape 
of all the serous or sero-sanguineous fluid contained in the sac, 
varying in quantity according to the duration of the hernia. 

The contents of the hernial sac are now exposed. They consist 
of the testicle, pushed outward, against the commissure of the 
ring ; the loop of the intestine, placed on the inner side of the 
spermatic cord, rarely extending as far down as the testicle, but 
usually reaching to the level of epididymis, and again, not un- 
commonly remaining in the condition of a bubonoale. But what- 
ever may be the dimensions of the protruding loop, the intestine 
is always easily recognized by the roundness of its form, the smooth- 
ness of its sui'face and its color, which may range from various 
shades of red to bluish black. It is also recognized by the changes 
which have taken place in its consistency, resulting from the bloody 
and serous infiltration which has taken place in its structure. The 
intestine should now be carefully wiped off with a soft, fine sponge, 
or washed with lukewarm water, in order to free it from any de- 
posits or adhesions of serous or bloody matter that may be present. 

The opening of the hernial sac should be immediately followed 
by the exploration of the neck with the index finger, with a view 
to the determination of the exact point where the strangulation 
exists, and to judge of its degree of tightness. This will not be 
found upon the superior opening of the inguinal canal, as thought 
by Gu-ard, D'Arboval, Hertwig, Hering, Laf osse, Rey, Verrier and 
others, but should be looked for two or three centimetres below that 
opening, as demonstrated by Bouley ; that is, where the neck of 
the vaginal sac is situated. This point made out, if the hernia is 
very recent, and the intestine has not yet become the seat of thick- 
ening, a few tactical manipulations can be apphed, the internal 
face of the vaginal sac having first been lubricated with sweet oil, 
or some mucilaginous substance, or even oO. of belladonna ; and 
even cool irrigation has been of service. In the performance of 
this taxis the first step is committed to the assistant, who stretches 
both borders of the sheath in order to separate them in the form 
of a funnel, the testicle being di'awn outward, in order to stretch 
the cord also. The operator then applies both hands upon the loop 
of the intestine, and with moderate and gradual pressure endeavors 
to push it through the neck of the vaginal sac. Eectal taxis applied 
at the same moment may also be of great assistance. But these 



408 



OPERATIONS ON THE DIGESTIVE APPARATUS. 



efforts must not be persevered in too long. If not successful al- 
most immediately, it is better to have recourse at once to the in- 
cision of the neck of the sac than to expose the intestine to the 
subsequent effect of j^i'essures or tractions of vs^hich the termina- 
tion may be a fatal gangrene. The following steps are recom- 
mended by Bouley in making this incision. Says this author : " One 
assistant takes hold, with both hands, of the edges of the incision 
made through the vaginal sac, stretching them into a funnel shape ; 
another draws the testicle outward and backward, to stretch the 
cord. Then the operator having explored with his finger the con- 
dition of the neck, introduces the blunt bistoury or the herniotome 
(Fig. 386) as far as the neck of the sac, taking for his guide the 
index finger of his right hand (Fig. 388), introduced 
into the neck or canulated director, and holding the 
instrument in such a manner that its 
back rests against the pulp of the fin- 
ger which supports it, and its sharp 
edge turned outward, corresponds to 
the stiffened band of the neck, to- 
wards the internal face of the thigh. 
This band will thus become stretched 
over the knife in such a manner that 
it divides itself upon the sharp edge 
of the instrument, with the aid per- 
haps of the slightest pressure made 
by the finger which supports it. The 
important point is to make a very lim- 
ited incision, dividing only the thick- 
ness of the vaginal sac and its fibrous 
covering, and avoiding the wounding 
of the cremaster, that being one of the 
conditions of the closing of the sheath. 
The division once made, the degree of 
dilatation of the neck is readily made 
out, and if the finger can be easily in- 
troduced into it, the reduction of the 
hernia becomes then an easy task. 

The modus operandi by the use of 
the herniotome differs but little from 
the preceding. When this instrument 



-J 



c 



HERNIA. 409 




Fig. 388. — Holding the Bistoury upon the Grooved Director. 



is to be used, a careful measurement of the amount of opening to 
be allowed to the blade must first be made. Then, guided by the 
side of the index finger, and with its blade turned outward, the 
instrument is introduced into the sac. "When it has reached the 
proper point where the division is to be made, the blade is brought 
out by pressing upon the peculiarly-contrived handle of the instru- 
ment, and the division of the band of the neck is completed. 

After the division at the point of strangulation, the taxis is to 
be used, both externally and by the rectum, carefully taking into 
consideration the condition of the intestines in the application of 
the various manipulations required. 

Upon reduction of the hernia, obUteration of the sac is secured 
by the application of a clamj), curved or straight, upon its parietal 
layers, embracing between them the spermatic cord. In short, 
the final steps of the operation will be precisely those by which 
the operation of castration with covered testicles is completed. 

This methed of closing the vaginal sac is the best, the simplest 
and the most certain in its results. It is true that the objection 
that it impUes castration is a weighty one, but the mutilation 
which it involves is a condition of radical recovery which cannot 
be obtained by any other means. The attempts which are made 
to save the testicles, which are justifiable only in the case of very 
valuable animals used for breeding purposes, are nearly always 
followed by fatal results. 

Among these may be mentioned the process by which, in- 
stead of leaving the testicle to drop under the effect of the 
pressure of the clamp, it is left inclosed in the vaginal sac, whose 
divided edges are brought together by sutures. 

Schmidt has attempted to push it back into the abdomen ; but 
such methods have been followed by fatal peritonitis. Bouley has 



410 OPERATIONS ON THE DIGESTIVE APPAEATUS. 

also advised a subcutaneous herniotomy, whicli was put into prac- 
tice afterwards by Siegen & Verrier, in which the careful punctiu'e 
of the sac was made at the origin, or, preferably, at the flabelH- 
form insertion of the cremaster. After enlarging the opening, the 
index finger is introduced into the neck, carrying with it the blunt 
bistoury with which the structure is divided, and the reduction is 
completed by the taxis, the wound being closed by several points 
of suture. The use of antiseptics in our day obviates a large 
portion of the danger arising from the comphcations which may 
follow these modes of operation. 

The operation for strangulated hernia in the gelding does not 
differ much from that indicated for stallions, excej)t in the man- 
ner of closing the wounds, the clamp, in this class of patients, 
being applied upon the hernial sac, involving the skin, as is done 
in some cases of treatment for umbilical hernia. 

The treatment of the patient subsequently to the operation is 
generally a simple matter, the violent colics, with other manifesta- 
tions of the hernia, having suddenly subsided, and the patient 
being comparatively free from pain. He will probably give evi- 
dence of some slight abdominal uneasiness, which will probably 
be due to the pressure of the clamp upon the testicular cord, but 
this will not be of long duration, probably requiring no other at- 
tention than a moderate walking exercise. 

The animal is then turned loose in a box stall and placed upon 
a diet suited to his case, and watched for future developments. 
The wound requires no special attention but cleanhness, and 
towards the fifth or sixth day, when the suppuration is estab- 
lished, the clamp can be removed. 

It is about this time that comphcations may be looked for. A 
fatal peritonitis, for example, may appear between the fifth and 
tenth day, when everything has seemed to be progressing favor- 
ably, and bid defiance to treatment, esjoecially if the intestines 
were already in a gangrenous condition when the reduction was 
made. After ten days there need be no more fear of comj)lica- 
tions, so far as the hernia is concerned, but it is not yet too late 
for those of castration, which may still occur. The duration of 
convalescence will average from twenty to twenty-five days, after 
which the animal can resume his work. A return of the hernia, 
recidive, is a rare and almost impossible event when the reduction 
has been completed by castration. 



HERNIA. 411 

During the operation certain accidents may occur, including 
eventration, an extra vaginal hernia and injuries to the intestines. 
At the present time, eventrations are rare, by reason of the fact 
that the division of the superior ring itself is no longer per- 
formed. Yet they may occur through an accidental slip of the 
knife, or a tearing of the walls of the vaginal sheath during ma- 
nipulation for the reduction, and the accident is usually a fatal one. 

Of extra vaginal hernia, Bouley says: "While making the in- 
cision of the neck, sometimes the cremaster muscle is divided in 
the direction of its length ; an accident possible, especially when 
one uses the concealed herniotome, and when too much freedom 
is allowed to its blade. It is then possible that the intestines may 
become engaged through this incision, and appear outside of the 
vaginal sac, above the inguinal ring. If at this moment, by mis- 
applied taxis, the intestines should fail to re-enter the cavity of 
the sac, eventration may take place. But if, on the contrary, the 
intestine is first carefully returned into the vaginal cavity, and 
then into the peritoneum, the edges of the peritoneal opening of 
the canal being intact, the intestines will then be prevented from 
making another exit." 

Woicnds of the intestines may take place either through a 
misdirection of the bistoury during the struggles of the animal, 
or possibly from the nails of the operator or his assistants, and 
the fact of their possibility suggests a sufficient hint touching the 
obvious means of obviating their occurrence. The gravity of 
these injvmes will be measured by their extent. 

Old iNGTJiNAii Heenia. 

Old, or chronic inguinal hernias, are those of which the charac- 
teristic condition is that owing to the state of dilatation of the vag- 
inal sheath, the intestine contained in it is enabled, without jeop- 
ardy to the life of the patient, to continue its function in the same 
manner as if it had remained in the open cavity of the abdomen. 
The vaginal sac has in this case become a kind of large diverticu- 
lum of such dimensions as to allow, without interference, the work 
and motion of the intestinal tract, lodged within it, to go on in a 
natural way. These hernias are divided into continued, or ^)er?>i«- 
nent and intermittent — a division elsewhere alluded to — but they 
may also be distinguished as simple and complicated. 



412 OPEEATIONS ON THE DIGESTIVE APPAKATUS. 

Among the varieties belonging to the latter category may be 
named: the laceration of the superior opening of the testicular 
sheath; the collection of serosity in the sac (hydrocele); the sar- 
comatous transformation of the testicle where the hernia exists 
(sarcocele); the adhesion of the intestines to the walls of the sac 
(irreducible hernia) ; with obstruction and strangulation. 

Although their causes belong to the list which we have already 
considered, there is still a sort of latent difference observable in 
the effects to which they severally give rise, as evidenced by the 
slowness and tardiness of their maturity. They often appear, also, 
as a sort of relapse or reactionary sequelae (recidive of the French) 
of acute hernia improperly reduced, or as a consequence of the ab- 
normally dilated condition of the upper ring, while this constitutes 
a predisposing cause. But this same condition of dilatation may 
be congenital, and in animals with a predisposing conformation 
chronic hernia of the intermittent kind is of easy occurrence. 
Whatever may be their mode of formation, however, they are gen- 
erally of long standing, and readily diagnosticated by their positive 
and familiar characters. 

Chronic hernias are generally of larger dimensions than the 
acute, and when exclusively vaginal, filling the cavity of the scro- 
tum and forming a true oscheocele. If the laceration of the supe- 
rior opening of the canal has allowed the formation of a sac and of 
an adjunct tumor, in front and outside of the cord, the hernial tu- 
mor will then consist of two lobes, the smaller situated in the depth 
of the groin, under the ventral walls, and the larger occupying the 
scrotal sac. 

These hernial tumors are usually formed by the small intestines 
and the floating colon, in exceptional cases, by the pelvic curva- 
ture of the colon as well. They vary also in volume as well as in 
consistency, from an obvious cause ; enlarging after meals, to con- 
tract again when the abdomen is empty ; and again, giving various 
impressions under the hand, according as their contents are gas- 
eous, liquid or sohd. In the first condition, when the intestines 
are empty and the animal is at rest, the tumor is soft, supple, elas- 
tic and more or less reducible, but when the animal is in action it 
increases in bulk, and becomes more tense and elastic, and less 
easy of reduction. There is therefore a condition of intei-mittency 
in their character, which is due to the pecuUar conditions in which 
the animal may be placed. The form of these tumors corresponds 



HERNIA. 413 

to that of the testicvJar sac in which they are contained, the in- 
guinal oscheocele being j)yriform, with its contracted portion 
resting in the groin. 

Vermicular movements of the intestines and borborygmus are 
symptoms easily detected in large hernias. The tumor of a 
chronic hernia is painless, or nearly so. Rectal examination 
furnishes evident indications of the jDOSsibility, and of the 
presence of the hernia by the degree of the dilatation of the ring 
and the size of the organ engaged in it. In such a case, the dila- 
tation may be so great, even notwithstanding the presence of the 
intestines, that the hands, placed respectively, one in the rectum 
and the other in the inguinal region, can be brought in such near 
proximity as to touch each other. All these symptoms, taken to- 
gether, or even isolated, are sufficiently characteristic to establish 
a positive diagnosis of simple chronic hernia. 

The serous exudation which necessarily exists in chronic 
hernia, may, when it is excessive, render the natvu-e of a hernial 
tumor more obscure, and give it the appearance of a case of true 
hydrocele, the serous sac in these cases being so full as to render 
it impossible to discover, either by sight or feeling, the presence 
of the intestines contained in it, even the elastic resistance of its 
walls being undetectable. But here a rectal exploration will help 
to solve the question ; and, again, by placing the animal in the 
dorsal position, the gravitation of the hquid into the abdomen 
will readily reveal the truth by leaving the intestine alone in the 
sac. 

Great caution is necessary in these doubtful cases, in which 
a misdirected stroke of the bistoury, thoughtlessly or accidently 
made, might prove certainly fatal, by incising the intestinal 
knuckle, which it really is, instead of simply opening the mere 
serous sac which it was supposed to be. The formation of a 
sarcocele may also render the diagnosis difficult. In these cases 
the testicle, considerably tumefied, rough on its siu'face, and hard 
and painful, is felt at the bottom of the sac, and thus conceals the 
character of the hernia. Still, with sarcocele hernia coexistent, 
the scrotal tumor acqviii'es an appearance and proportions differ- 
ent from those of its uncomi^licated state. In this last case, the 
testicle constitutes the principal mass, and the elongated cord, 
stretched by the weight of the organ, can be easily traced with the 
fingers quite up into the groin. If, on the contrary, both hernia 



414 OPERATIONS ON THE DIGESTIVE APPARATUS. 

and sarcocele are present, the testicle is bosselated and hyper- 
tropbied, and the cord which sui)i:)orts it is surrounded by the 
protruding intestines, which form on the outside an elongated 
mass, of a consistency either puffy or perfectly elastic, according 
to the period of digestion. Intelligent rectal exploration will 
always reveal the presence of the intestine through the ring. 

When chronic inguinal hernia becomes complicated with acute 
inflammation of the displaced organ, the scrotal tumor becomes 
warm, painful, evenly tense and remittent, and assumes nearl}' all 
the characters of a phlegmonous tumor, that a strong tempta- 
tion is oflfered to open it with the bistouiy. But, if this is con- 
templated, it should be preceded by a rectal examination, carefiilly 
made, as the only means of avoiding a possible error of diagnosis 
whose consequences would be fatal. If the inflammation con- 
tinues to be localized, the intestine contracts adhesions with the 
walls of the sac, and the hernia becomes irreducible; but if, on 
the contrary, the phenomena of inflammation extend to the peri- 
toneum, an acute peritonitis is established, and the patient suc- 
cumbs in a few days. 

The obstruction or engorgement^ which is a possible complica- 
tion of chronic inguinal hernias, consists in the distension of the 
intestinal loop by the lodgment of alimentary masses of varying 
bulk which accumulate, and for the time being, occlude the intes- 
tinal tract. This complication may be recognized by the in- 
creased volume of the tumor, its greater weight, and the sensa- 
tion of a softish and puffy mass contained in it. It is often, how- 
ever, but a temporary trouble, the colics which attend it yielding 
easily to appropriate treatment, and the removal of fseces from 
the rectum by back-raking being often sufficient in itself to afford 
relief. But in exceptional cases, treatment fails ; the obstruction 
becomes persistent ; the faeces accumulate in the protruding in- 
testines ; the tumor is increased in bulk, and at length a period 
arrives when such a disproportion between the volume of the dis- 
tended intestine and the capacity of the opening through which 
it has passed is established, that all the conditions necessary for 
strangulation are fulfilled. This soon takes place and becomes 
evident by the exhibition of symptoms akin to those pertaining 
to its analogue of the recent or acute variety. There is, how- 
ever, a difference between the two forms in respect to the impor- 
tant matter of their comparative amenability to treatment, inas- 



HEKNIA. 415 

mucli as while strangulation in the acute cases is only relieved 
with great difficulty, withou.t resorting to the operation of herni- 
otomy, it is not uncommon in those of a chronic character, also 
strangulated, to succeed by a careful exercise of the taxis, in dis- 
placing the alimentary mass which causes the obstruction, and 
thus forms one of the contributing conditions of the strangula- 
tion. It is only in case of failure in this endeavor that herniot- 
omy becomes admissible. 

A chronic inguinal hernia is always a serious ailment, though 
not necessarily incompatible with the Ufe and health, and even 
partial usefulness of the horse. It must, however, constitute a 
blemish which cannot fail largely to depreciate his commercial 
value, since it must always be liable to interfere with the efficient 
performance of his accustomed labor, besides keeping him in a 
state of greater or less exposure to complications and tendencies 
which are a constant soiu'ce and menace of danger to the valetu- 
dinarian animal. 

Operations for the relief of hernia are always attended with a 
certain gTa\'ity, even when they are of the simplest character of 
which they are capable, and if compUcations exist the danger 
must necessaiily be intensified and aggravated, even to the ex- 
tent of jeopardizing the hfe of the patient. In the excellent 
work of Peuch & Toussaint, speaking of the applications of treat- 
ment, they remark : "In animals less than fifteen months of age 
suflering with hernia, the expectant method is the proper indica- 
tion, since the lesion may disappear as the animal gets older and 
develops. Inguinal hernias of smaU size must be left alone, not 
interfering, while in that condition, with the work of the animal. 
The operation in chronic inguinal hernias, complicated with lacer- 
ation of the superior opening of the inguinal canal, and conse- 
quently with ventral hernia, is contra-indicated by the imminent 
danger of the occurrence of eventration during the operation, or 
when the clamj) is removed. When, however, the hernial tumor 
has assumed such enormous dimensions, that, like the udder of a 
cow, it hangs down to the hocks, there is no more contra-indica- 
tion, the animal being then useless - and yet some slight chances 
of success still remain. Hernias complicated with hydrocele, sar- 
eocele or obstruction, are cases calling for operation, and when 
the point of strangulation has been reached, the indication of 
immediate and urgent interference is imperative." 



416 



OPEKATIONS ON THE DIGESTIVE APPARATUS. 



To this we may add, with Bouley, that the operation is also 
indicated when the hernia is exclusively vaginal and of sufficient 
proportion to interfere with the locomotion of the patient. It is 
also indicated as a means of preventing its further development. 
The operation for chronic inguinal hernia identifies itself with 
that of castration with the use of the clamp, and by the process 
known as covered testicles, as it is by this alone that the accom- 
plishment of the ultimate purpose in the reduction of the hernia 
and release of the strangulation can be obtained. The instru- 
ments required are those needed in castration. The clamp, how- 
ever, requires to be of increased length and dimensions, and 




Fig. 389.— Straight and Curved Clamp, 



curved, in order to adapt itself to the parts. A broad cloth, such 
as a bed sheet, may prove useftil to receive and protect the intes- 
tines in case they should protrude too extensively. 

The animal is placed in the decubital position on his back, 
with the leg of the affected side maintained in abduction. Anes- 
thetics are generally used, especially when there are fears of com- 
plications, while, in fact, they ought never to be omitted. The 
operator then, with the convex bistoury, makes carefully, on the 
inferior border of the hernial sac, an antero-posterior incision, 
parallel to the median raphe of the scrotal region, cutting through 
the skin, the dartos and the first layer of the cellular tissue under- 
neath. He then with his hands tears the adhesions which exist 
between the dartos and the tunica erythroidea, in order to enucle- 
ate the hernial tumor in its entirety. This step is easily effected 
when the cellular tissue, which covers the fibrous coat, is not in- 
durated, but if that should be the case when adhesions exist, the 



HERNIA. 417 

dissection should be carefully made with the knife until the ad- 
hesions are completely divided and the fibrous coat fully exposed. 
The reduction must then be attempted without opening the sac, 
and in the absence of any adhesions this is effected without diffi- 
culty, the inguinal opening being so large that, through the force 
of mere gravitation, the dorsal position in which the animal is 
placed is often sufficient in itself to cause the return of the intes- 
tines into the abdominal cavity, even the testicle and the hernial 
sac often following it in its inward movement. 

If the reduction does not take place in this manner, or in con- 
sequence of the position of the animal, the taxis, both scrotal 
and rectal, is then indicated to be performed in the same manner 
as for acute hernia. Difficulties in effecting this reduction may 
arise from three causes — either, first, the bulk of the mass repre- 
sented by the protruding intestines ; or second, its obstruction ; 
or third, the adhesions which it may have contracted with the 
walls of the sac or with the spermatic cord. 

To obviate the first difficulty, while the manipulations of the 
taxis, scrotal and rectal are simultaneously continued, it will 
be well to relieve the jDOsition of the animal, and instead of keep- 
ing him lying absolutely on his back, to allow him to turn 
shghtly, and to rest on the side opposite the hernia. In this 
way the mass wUl not be so heavy to manipulate, and will be in a 
better position to foUow the dependent dii-ection in which it 
must be pushed by the scrotal taxis, while at the same time, by 
the rectal manipulation, it can be more easily unfolded and drawn 
from the cavity in which it was imprisoned. But if, notwithstand- 
ing all these precautions, this difficulty in the reduction cannot be 
overcome, the indication of opening the sac still remains. 

The incision of the sac is performed as in cases of recent 
hernia, the bed-sheet already mentioned being held in readiness 
to receive the intestinal mass as it vvill be exposed. Then the 
animal being completely under the influence of ether, and in the 
dorsal position, an assistant grasps the edges of the sac and 
stretches them apart, funnel-wise, using both hands alternately, 
gradually pushes the intestines towards the hernial opening, an 
assistant at the same time slowly unfolding the mass and permit- 
ting it to sUde into the abdominal cavity. 

Rectal taxis may largely assist in this step of the operation. 

If the reduction is rendered impossible by the interposition of 



418 OPERATIONS ON THE DIGESTIVE APPARATUS. 

obstructions, the first indication will be to evacuate the intestines 
by a methodical pressure which will displace the alimentary mass 
and return it toward the abdomen. The puncture made with the 
aspirator has proved very beneficial in these comphcations. 

The adhesions require the most careful dissection, especially 
when they are short, and when both the visceral and parietal 
layers of peritoneum are closely tmited. The separation must be 
done by a succession of short, limited incisions, at the expense of 
the thickness of the parietal layer. 

When strangulation of chronic hernia occurs, it is due not to 
want of room at the hernial ring, but to the enlarged bulk of the 
protruding organ, which constitutes the obstruction Conse- 
quently the indication for herniotomy is not present. On the 
contrary, as serious eventration is always to be feared, the only 
indication is the removal of the obstruction as already indicated. 

"When the reduction has been completed, the occlusion of the 
vaginal sac is to be obtained by the application of the clamp, 
applied as high up as possible, as in cases of strangulated acute 
hernia. 

In cases of inguinal, complicated with ventral hernia, attempts 
at reduction may be made by placing a long clamp over the cov- 
erings of the latter, involving with them the hernial sac and its 
cutaneous envelope, as practiced in some cases of the umbiHcal 
form. 

We need but briefiy to refer to certain different modes of treat- 
ment of the various forms of hernia by the use of bandages, rec- 
ommended by Petard, Grau, Klinger and Marlot, together with 
the application of sutures upon the edges of the inguinal canal, 
patronized by Hertwig and Dieterichs, to say that none of these, 
any more than some others, borrowed from human surgery, can 
give more satisfactory results, or be employed with greater safety, 
and effect a radical cure better than the use of the clamp and the 
castration by the process of the covered testicle. 

Inguinal Hernia in Geldings. 

Although inguinal hernia in the gelding is certainly less com- 
mon than in the stallion, it is not, therefore, of impossible occur- 
rence. But from the fact of its rare appearance it is far more 
likely to be overlooked, and therefore neglected, with similar fatal 



HERNIA. 419 

results to those in tlie stallion, when it reaches the stage of 
sti'angulation. 

From the fact that, as the result of castration, the superior 
opening of the testicular sheath is more or less closed, it becomes 
a matter of rational inference, that hernia in a gelding is not of 
posterior occurrence to castration, but that its existence is due to 
a congenital disposition, and that by the operation of gelding they 
have been reduced to their smallest proportions, in relation to the 
dimensions of the intra- vaginal sac, to the dimensions, in fact, 
of a bubonocele, which continues unobserved in consequence of the 
smallness of its size, and the depth of its location. 

These hernias are detected outwardly by a physical symj)tom, 
to wit, the existence in the inguinal region, on either side of the 
penis, and above the cicatrix of castration, of a ttmior about the 
size of an egg, soft, depressible, altogether painless, sometimes 
elastic and at times puffy. It varies much in size, diminishing 
with rest and quiet, and increasing with effort and active move- 
ment. It may, in fact, under the first condition, entirely disap- 
pear, to return as soon as the animal is put to work. In a word, 
it has the true character of being intei*mittent. Aside from these 
symptoms, rectal exploration furnishes positive data of its exist- 
ence, by the abnormal dilatation of the ring, easily detected, and 
by the pressure of the intestines lodged in it. 

This hernia is also susceptible of strangulation, and is then ac- 
companied by violent abdominal pains, which must not be ignored 
as to theu' possible diagnosis and significance. The indication 
for careful examination in that direction must, indeed, never be 
overlooked in cases of violent coHcs in geldings. If these colics 
are due to strangulated hernias, the presence of a round, tense, 
resistant and painfull tumor will be detected in either of the in- 
guinal regions, and, according to Bouley, more commonly on the 
left than on the right side. The strangulation in this class of 
hernia is generally irreducible, and becomes rapidly fatal ; if not 
reheved immediately, it is not reheved at aU. 

The first indication of treatment is the reduction of the hernia 
by simple, external taxis, or by combining with it the rectal taxis. 
The reduction will be followed by the disappearance of all the 
symptoms, and the animal will be apparently well, until a second 
attack takes place. After the reduction, steps must be taken to 
prevent its return, by an operation similar to one of those used ia 



420 OPERATIONS ON THE DIGESTIVE APPARATUS. 

umbilical hernia, to obtain tbe reduction and retention of tiie in- 
testine, by the application of a proper clamp upon the sac cov- 
ered by the scrotal skin. 

The treatment of the gelding for strangulated hernia does not 
differ from that of the staUion. Ordinarily, the taxis is sufficient 
to reduce such compHcated hernia, but in case of failure in obtain- 
ing rapid success one must be careful not to carry on the manipu- 
lations so long as to encounter the risk of lacerating or tearing 
the tissues. The wiser and safer plan will then be to have recourse 
to the operation of herniotomy, an operation which should be 
performed with the greatest care in separating and dividing the 
existing cicatricial adhesions of castration. The clamp is after- 
wards placed upon the hernial sac, with its cutaneous covering, 
requiring a longer time to slough, and constituting a means of 
retention most favorable to the success of the operation. 

Crural Hernia, 

or merocele, is that form of rupture in which the abdominal 
organs make their escape through the crural ring. It is a rare 
affection among our domestic animals, but has been seen by La- 
fosse, Jr., in the horse, by Girard, Jr., in the dog, by Dandrieu in 
cows, and by Hertwig in horses, donkeys and dogs. It is said to 
be more frequent in males than females. It results from violent 
muscular efforts, and especially from the slipping apart of the legs 
when already separated or straddling in abduction. It is char- 
acterized by a somewhat well defined tumor, of moderate size, 
situated behind the inguinal ring, towards the middle of the flat 
part of the thigh. When the rupture is recent, the animal is some- 
what stiff in his gait, especially on the affected side, and carries 
his leg in abduction. There is also a degree of lameness. Accord- 
ing to Hertwig, the tumor is easily reduced, and not very painful. 
In a few cases it may be complicated with strangulation. The 
organs which have been found in the sac have been portions of 
the small intestines ; the omentum, as reported by Hertwig, and the 
bladder, in one cow, according to Dandrieu. The prognosis in 
cases which receive early attention, is not serious. 

The treatment consists in reducing the rupture, and afterwards 
closing the passage through which it occurred. This is effected 
by making an incision through the skin over the tumor, and closing 



HERNIA. 421 

the ring with a few stitches upon Poupart's ligament and the small 
adductor of the leg. A good bHster rubbed over the enlargement 
completes the treatment. According to Zundel, three weeks of 
subsequent rest are required to assure recovery. 

Perineal Hernia. 

This is a very rare lesion and, as Zundel describes it, is the pas- 
sage of the peritoneum and viscera through the vasculo-aponeur- 
otic floor of the bottom of the pelvis. It is, however, reported to be 
common in dogs, in which animal it is situated between the ischium, 
the sacrum, the anus and the lu-ethra, and is often mistaken for an 
abscess. It is more frequently formed by the bladder than by the 
intestines. 

Pancreatic Hernia. 

This hernia was first observed by Prinz, and afterwards noticed 
by Husson, Eoell, and others. It is caused by the strangulation 
of the jejunum and the anterior part of the ileum through the 
hiatus of Winslow, the orifice above the right angle of the pan- 
creas, and of the vena cava, in front of the right kidney. It is 
accompanied by symptoms of intestinal congestion, and cannot be 
reached by any form of treatment, if indeed it can be accurately 
diagnosed during life. 

Pelvic, or Internal Hernia of Oxen. 

This form of hernia is principally described by Zundel, from 
whom we extract the following : " It is the strangulation of a loop 
of intestines, which has pushed through the ruptured peritoneum, 
from before backward, between the testicular cord and the lateral 
wall of the pelvis, the rupture of the peritoneum having resolved 
during some of the manipulations of castration from excessive 
stretching of the cord, as in the operation by tearing. It is, there- 
fore, exclusively a lesion of the ox, and cannot affect the biiU. It 
is quite common in Germany, and has been met with in England, 
Mecklenburg and Alsace. It was first described by Oesterten, in 
1811, followed by Anker in 1824, and later by Zundel, Ostertag 
and Tues. It is comparatively often seen, and in many cases over- 
looked. The first intimation of the presence of the disease appears 
in the onset of symptoms of a violent attack of coUc. The animal 
becomes anxious and restless, lies down hastily and rises again 



422 OPEEATIONS ON THE DIGESTIVE APPARATUS. 

suddenly ; turns about, moves to and fro, lashes with his tail, and, 
in'a word, betrays all the usual signs of intense suffering, and it 
becomes difficult, if not dangerous, to approach him in order to 
make a proper examination. The temperature of the body is ele- 
vated, there is some perspiration, the nose is hot, though still 
moist ; both respiration and circulation are accelerated. The ani- 
mal refuses food or drink, rumination is suspended, and though 
defecation has not ceased, the fseces are hard, blackish and coated. 

In from six to twelve hours, this state of febrile excitement 
subsides, and the animal becomes dull and quiet, gazing towards 
its flanks, the ears dropping, the hind leg coiTesponding to the 
side of the hernia is extended backward, and at the same time the 
lumbar region is relaxed downward. If the animal is lying down 
he may remain quiet for a while, with his hind leg stiU extended, 
but will presently spring to his feet with his back arched as before, 
at the lumbar region, but which drops agaia and straightens im- 
mediately. When he walks it is with a stiff action, principally 
towards the diseased side ; the extremities are cool, the pulse is 
small and insensible, respiration is accelerated ; constij)ation at 
length becomes complete with mucous and bloody passages, jDer- 
haps accompanied with flatulence, but micturition is still easy. 

Two or three days later there are other changes. The period 
of calm terminates, and is succeeded by a season of alternating 
agitation and repose — action and reaction of the fluctuating in- 
flammatory process. 

The animal now and then utters grunts of pain, his pulse be- 
comes smaller, and is at length imj)erceptible, and all the un- 
favorable manifestations are exaggerated. Either gangrene has 
supei'vened, or, as some would judge, enteritis, and all the symp- 
toms point towards the more fatal termination. 

It is only by rectal examination that the diagnosis can be j)osi- 
tively established, and when this has been carefully and success- 
fully made, he will have discovered what may be thus described : 
a puffy mass, indefinite as to size, situated usually nearer the 
sacrum than the pubis, on the side of which, generally the right, 
a portion of the intestines has sHpped under the testicular cord — 
this being the definition of a crural hernia. It may be a simple 
protrusion of the intestine, and again, this maybe twisted around 
the spermatic cord, a condition particularly likely to terminate in 
strangulation. 



HERNIA. 423 

This lesion may continue as long as nine days, four to five 
being the average duration, and it may terminate by spontaneous 
reduction, but the trustful surgeon vyho too confidently and too 
often expects to find that Nature has dispensed with his aid in 
this kindly way, is doomed to encounter many disappointments. 
Or it may end in gangrene or enteritis. 

The fact that the disease, if not interfered with, may terminate 
fatally in so brief a period as five days, of course renders the 
prognosis quite a serious one, unless the nature of the ailment 
has had an early identification and measures have been taken to 
avert the danger. The gravity of the prospect is, of course, in- 
creased when the compUcation with strangulation or enteritis, as 
before mentioned, enters into the case. 

The treatment, as in other cases, consists in the reduction of 
the hernia. With a small proportion of patients this may be 
efiected by the simple act of causing the animal to walk down a 
steep declivity — a sort of spontaneous, or semi-spontaneous cure, 
from which, although founded on anatomical principles, too much 
must not be confidently expected. We coj^y from Zundel his de- 
scription of other and more scientific methods : 

{a) Reduction by Simple Taxis. — The animal is placed on an 
incHned plane, with his hind-quarters raised, and an assistant on 
one side of him ready, at a given moment, to press on the loins. 
The operator, with his hand in the rectum, searches for the in- 
testinal loop, and when he has found it, holding it in the bottom 
of his hand, he feels for the opening under the spermatic cord, 
which he dilates with his fingers, and now, while the assistant 
presses hard on the loins, as just mentioned, the intestine may 
be readily felt moving downward and forward under the cord, to 
resume its normal position. Although simple, and, in the ma- 
jority of cases, successful, this mode has the defect of leaving the 
animal exposed to a return of the hernia. 

{b) Reduction by Laceration of the Cord through the Rectum. 
: — This method is recommended by Metzger, Eisele, Schenck, 
Gierer and Ostertag. It consists in tearing away the adhesions 
formed by the stump of the cord after castration, and loosening 
it from the inguinal ring. It is, however, difficult to do, and not 
without danger. The hand being introduced into the rectum, 
and the opening found, the fingers are closed in the form of a 
wedge, and with a slight movement of rotation pushed through 



424 OPEEATIONS ON THE DIGESTIVE APPAKATUS. 

the opening, and tlie cord thus separated from its adhesions. 
After a while, the pressure, which was quite firm at first, dimin- 
ishes, and the intestine gradually returns to its position. This 
mode is slow in its steps, but it is successful in its results, even 
in cases of obstruction and of strangulation. When it fails, it is 
because of the strength of the adhesions between the cord and 
the abdominal walls, or the inguinal canal. 

(c) Division of the Stricture through the Rectum. — To per- 
form this operation, invented by Schmidt, a trocar about sixty- 
five centimeters (some thirty-five inches) long is necessary. This 
trocar has its point attached with a screw, in order to permit its 
removal and the substitution of a blunt bistoury. "With the left 
hand in the rectum, a fold of that intestine is secured a little be- 
hind the point of stricture, and the trocar pushed through it. 
The stylet of the instrument being then withdrawn, leaving the 
canula in place, the point of the trocar for the bistoury is then 
inserted, while the hand, still in the rectum, leaves the rectal fold 
loose, feels for the spermatic cord, raises it and guides the bis- 
toury against it, which with comparative ease completes the di- 
vision of the stricture. 

{d) Division of the Stricture after Incision of the Flank. — 
Through an incision made in the middle of the right flank, the 
hand is introduced and grasps the spermatic cord, which is then 
divided with a bistoury cache, or, which is better, mth the inside 
edge of a hook kept sharp, similar to the hook used in some cases 




Fig. 390.— Sharp Hook for the Section of the Testicular Cord. 

of distokia. The hernia being reduced, and the wound in the 
flank brought together with sutures, a circular bandage is apphed 
around the abdomen. With the reduction of the hernia, what- 
ever may have been the means of accompUshing it, the symptoms 
subside, and the treatment is completed by the administration 
of laxatives or sedatives, rectal injections, etc., as tke indications 
may require. 



425 



Umbilical Hernia. 

Umbilical hernia is the protrusion through the non-obhter- 
ated umbilical ring of either the omentum or the small intestine, 
or both. It is also known as an exomphalus or omphalocele. It 
receives the name of enter omphalus or epiplomphalus when formed 
by the displacement of the intestines, or that of the omentum 
separately, and when both of those organs are implicated it be- 
comes an entero-epiploniphalus. UmbiUcal hernia is quite com- 
mon in horses and dogs, not less so in bovines, and has been no- 
ticed in swine and sheep. It is most common in young animals, 
especially soon after birth, is at times congenital, and may be long 
continued, even to adult age, or for eight, ten or twelve years. 

Umbilical hernias are either congenital or accidental. The 
former are formed during foetal life and continue at birth, al- 
though, according to some authors, they are, strictly, not so 
much congenital as accidental, and are, in fact, the result of the 
pulling and stretching of the umbilical cord during the act of de- 
livery. However this may be, they do usually, in fact, make their 
appearance during the second and third months following birth, 
when through the persistency of the opening, and the imperfec- 
tion of the umbiHcal cicatrix, the intestines are enabled to pro- 
trude through the ring, and subsequently to prevent its closing 
by their presence. But again, while the cicatrix is weak, the ac- 
tive exercise and forcible movements of the young animal while at 
play may cause the rupture ; and still, again, the protrusion may 
be caused by intestinal derangements. Indeed, all traumatic 
causes, such as contusions, blows, and any violent efforts taking 
place diu:ing the period of consolidation of the closing cicatricial 
tissue, may become an originating cause of this lesion. Animals 
of low and lymphatic constitution are much predisposed to this. 
trouble, especially such as feeble colts, born of mares badly cared 
for and insufficiently fed during gestation. Heredity fills a large 
place among the predisposing causes in low-conditioned mares with 
feeble organizations, and suffering with similar trouble when young, 
dams of this class naturally bringing forth foals of defective stam- 
ina, liable to perpetuate the same constitutional tendencies. 

The symptoms of umbilical hernia are generally exclusively 
local. It is characterized by a semi-globular or pyriform tumor 
situated on the median Hne of the abdomen at the umbilical ring, 



426 OPERATIONS ON THE DIGESTIVE APPARATUS. 

and varying in dimensions from the size of a lien's egg to that of 
a child's head — dimensions which may vary according to the con- 
dition of vacuity or fullness of the intestine ; the position of the 
animal, whether standing or lying, or according to the length of 
time it may have existed. The consistency of the tumor is very 
variable. It may be soft, easily dejjressed by the finger ; elastic, 
when distended with gases ; or soft and puffy when containing 
alimentary matter — these changes being accounted for by the na- 
ture of the organ. An enteromphalus will give the sensation of 
an elastic mass, while the epiplomphalus will form a puffy swell- 
ing. This species of hernia is almost always painless, and exhib- 
its as one of its peculiar and constant symptoms the character of 
being reducible. In the generality of cases, it can be made to 
disappear temporarily by the taxis and by forcing the protruding 
portion back into the abdomen, but only to reappear at once as 
soon as the pressure is withdrawn, especially if the animal is on 
his feet. On being thus reduced, the oj^ening of the ring can 
readily be detected, and the fingers may be freely introduced 
through its diameter and its form and dimensions ascertained 
shewing it to be sometimes eUiptic, sometimes circular, and some- 
times irregular, the originating cause of the hernia itself deter- 
mining the difference. 

Besides these more common symptoms of umbihcal hernia, 
there are others which can be detected by more careful examina- 
tion. For instance, on applying the hand over the tumor, the ver- 
micular motions of the intestines may be recognized, and by feel- 
ing in the hernial sac, the presence of fpecal masses may be discov- 
ered ; and it may be possible by auscultation even to detect the 
presence of borborygmus through the displaced intestines, and 
even to observe its true nature, by reason of the transparency of 
■ the sac and its envelopes. These are the most ordinary symp- 
toms of an exomphalus, although it is subject to complications, 
and the sjonptomology will vary accordingly. 

There are cases, but they are rare, in which the hernia be- 
comes irreducible. The most serious of these are such as are 
found to have become so in consequence of the formation of ad- 
hesions between the protruding organ and the hernial sac — a very 
infrequent occurrence. The most common cause will be the pres- 
ence of undigested masses of food accumulated in the intestines, 
such as hard balls of faeces or sand. 



HERNIA. 427 

Inflammation of umbilical hernia may follow blows or bruises, 
though such a result from these accidents is not a common one, 
and its occiu'rence will naturally be accompanied with changes 
in the appearance of the tumor, such as the usual phenomena 
attending inflammatory action, as increase of temperature, ten- 
derness or pain, oedema, etc., which may even at times so com- 
bine theu' effects as to render the hernia irreducible. Engorge- 
ments and strangulations, however, are very rare comphcations 
of this form of hernia, a fact easily understood when it is con- 
sidered that the neck of the hernial sac is formed by the umbiHcal 
ring itself. 

An exomphalus is usually an affection of Httle gravity, and 
often disappears spontaneously, or if it joersists after the period 
of weaning, is easily radically cured when the animal grows and 
develops. Yet even if undisturbed and unchanged, they persist 
in remaining, their existence is not incompatible with perfect 
health and full ability to labor, however they may reduce the com- 
mercial value of the animal. They are less injurious to young 
animals than to adults, and less dangerous when small than when 
assuming large dimensions. When simple, they are easily amen- 
able to treatment, but if compHcated they become dangerous, es- 
pecially so when the capacity of the ring is so disproportioned to 
the dimensions of the protruding intestines that strangulation be- 
comes an accident of easy occurrence Reducible hernia is at- 
tended with but little hazard, while the danger arising from the 
possible formation of adhesions in cases which have passed into 
the irreducible class becomes a matter of very serious import. 

If it is an admitted fact that animals suffering with umbilical 
hernia do often recover spontaneously, the recovery being a normal 
incident of the natural development of the animal, due to changes 
of position in the abdominal contents, not to specify other effi- 
cient causes ; then the question of immediate or early interfer- 
ence undoubtedly receives and justifies a negative answer. Our 
own testimony is that we know of cases where patient waiting, 
even for a period of twelve months, has been rewarded by the 
radical disappearance of the hernia. But the objections to such 
long waiting are of a tangible and serious nature, and siu'gical 
interference becomes imperative and indispensable. The persons 
are few who are able or wiUing to nurse an idle horse for a year 
for the sake of saving him from the pain of an operation. 



428 OPERATIONS ON THE DIGESTIVE APPARATUS. 

The object of all treatment is, of course, the reduction and re- 
tention of the hernia, but the means of doing so are various. 
They are mainly included under four heads. The first method is 
by bandages ; the second, by external or topical ajypUcations / 
the third, by surgical operatio?is for the cotistriction of the tumor ; 
and the fourth, such special treatment as may be required to meet 
comjMcations. 

1st. Bandages. — The bandage of retention is essentially a belt 
buckled around the body, by which a pad is kept over the open- 
ing of the umbilicus to prevent the escape of the abdominal con- 
tents, and temporarily perform their office in the subcutaneous 
hernial sac. It is designed to aid in the mechanical closing of the 
umbilical opening until that takes place by the process of physio- 
logical change in the sac and its borders. 

The forms of bandage in use are many and various, among which 
Peuch and Toussaint name four principal kinds. A most import- 
ant requisite in all of them is that while they possess the solidity 
and fixity necessary to retain the reduced hernia in place, they 
shall cause the minimum amount of discomfort to the patient. 

The bandage of Marlot, according to Zundel, is the one which 
best fulfills the three conditions of solidity, fixity and elasticity. 
It consists of a kind of padded saddle, with strajps at its four 
corners, buckling on two belts, the anterior or pectoral., which sur- 
rounds the chest like a girth, and the posterior or ventral., which 
presses the retaining pad against the umbilicy. This pad is a 
wide hair cushion of a moderate thickness, kept in place and pre- 
vented from sHpping back by a longitudinal girth connecting the 
pectoral and the ventral belts. 

The bandage of Massicra is much recommended in Italy. This 
also is a small saddle with two wide girths passing under the 
thorax, and pressing against the sternum and the epigastric re- 
gion, with a steel band corresponding at its posterior extremity 
with the umbilical ring, forming a plate padded with a hair cushion. 

The apparatus of Strauss, used in Germany, is made somewhat 
on the same principle, but is reinforced by a kind of breeches 
which prevents it from slipping backward. 

The length of time necessary for a patient to wear a bandage 
will vary with the dimensions of the hernia — from one to three 
months, according to Lafosse, being required to obtain a radical 
cure. Marlot claims that an average of thirty-two "days is all that 



HERNIA. 429 

is necessary. The bandages must be apj)lied only after the perfect 
reduction of the hernia, and the most acciu'ate adaptation of the 
pad to the umbihcal opening. These appHances are of difiiciilt 
adjustment and are unavoidably uncomfortable to the animal from 
their liability to chafe and excoriate the skin. They, therefore, 
constitute a mode of treatment which must necessarily be attended 
with uncertainty, and, therefore, as justifying only a careful and 
modified recommendation. Still, it has in the hands of many prac- 
titioners given very satisfactory results. 

2d. Local Applications. — The treatment by irritating local med- 
ication aims to produce in the tissues surrounding the hernial sac 
an inflammation which will end in a serous infiltration which wiU 
crowd away the protruding organ, prevent its return into the open- 
ing, and subsequently facihtate the obhteration of both the sac 
and the ring. This result is obtained by the use of certain chem- 
ical agents, which applied on the hernial tumor tend to produce 
various degrees of inflammation, from simple rubefaction to com- 
plete escharification of tissues. In former times sulphuric acid was 
recommended, and as late as 1833, Hertwig employed it in appli- 
cations made during two or three days. BHsters and their con- 
geners have had their day. Astringents have also been recom- 
mended, as also caustics, principally in the form of ointments, as 
that of chromate of potash, in the proportion of one part in eight, 
as recommended by Foelen — these also have had then- advocates. 
But of all these, nitric acid, applied externally, is the one which 
has proved most satisfactory and least dangerous. 

The treatment consists in applying acid upon the tumor of the 
exomphalus, in sufiicient quantity to produce an escharotic effect, 
and afterwards promote the sloughing of the cutaneous sac. The 
mode is thus described : After positive diagnosis of the nature 
and character of the tumor, the animal being kept in the standing 
posture, the hairs cut short, the acid is appHed over the entire sur- 
face of the sac, by rubbing it in with a brush, or a small ball of 
oakum secured at the end of a stick, and dipped into the acid — 
which should register 34" to 36° Baume — first passing it circularly 
over the base of the examphalus to define the place where its action 
is requii-ed, and then including the entire surface. A sufficient 
quantity of the caustic must be applied, and with enough energy 
to produce the disorganization of the skin in its entire thickness, 
and positively produce its mortification. Experience has proved 



430 OPERATIONS ON THE DIGESTIVE APPAEATUS. 

that the deeper the action of the caustic, the more successful the 
operation is likely to be. It is said that nearly one ounce of the 
acid is required for a tumor as large as a man's fist, and that the 
friction should be continued from three to five minutes. The 
duration of the friction and the quantity of the acid to be used 
must, however, be guaged by the dimensions of the tumor, and 
also with careful consideration of the thickness of the skin, Dayot, 
to whom is due the positive and practical introduction of this mode 
of treatment, proposes to apply the acid in instalments, and recom- 
mends that the apphcation be repeated once or twice an hour, 
according to the thickness of the skin, until the desired effect is 
assured. The result of our own experience is a conviction that as 
a rule only a single apphcation is necessary. Nitric cauterization 
produces a yellow eschar, which ordinarily remains for a long time, 
soft, supple, and unctuous to the touch, but the epidermis of which 
is easily lacerated. In some cases the formation of the eschar is 
followed by a large swelling of the cauterized parts and the sur- 
rounding tissues. Sometimes it makes its appearance immediately 
following the operation, but more commonly it appears at a later 
period, gradually increasing during the first hours following the 
cautery, although again, in other cases, this swelling is altogether 
absent The oedema is the direct effect of the action of the caustic 
upon the subcutaneous cellular tissue, which becomes infiltrated ; 
and in this condition apphes a uniform pressure in all directions 
upon the peritoneal hernial sac, crowding back into the abdominal 
cavity the displaced intestines and preventing their return by the 
kind of retentive bandage which is formed by the engorgement 
which takes place around the sac. 

In the days following, after reaching the maximum develop- 
ment, the oedema gradually diminishes by resorption, becoming 
at the same time somewhat harder, the portions of cauterized skin 
which is in its center meanwhile gradually drying, and becoming 
transformed into a dry, hard plate. 

In place of the hernia there now remains a fibrous mass of new 
formation, which gradually diminishes and is soon more or less 
resorbed. In the meantime, while these phenomena are taking 
place, the process of the separation of the eschar has begun and 
progressed, and on the eighth day, on the boundary between the 
dead and the living structures, a fissure shows itself, and minute 
granulations appear. The separation goes on slowly, from the 



HERNIA. 431 

circumference to the center, leaving, when complete, a rose siu'f ace, 
granulating evenly, small fibrous formations sometimes appearing 
in its center. This wound heals rapidly, lea'sang a contracted 
cicatrix, which assists in keeping the hernia in its place, while the 
indurated skin, which for some time remains adherent to the still 
fibrous, abdominal, subcutaneous tissue, contributes to the com- 
plete obHteration of the ring. After a month the cure is radical, 
and in place of the hernia, there remains only a hairless cicatrix, 
often without pigment. 

Though this treatment is simple, and has, by the resiilts it has 
shown, justified the credit it enjoys among those who have had 
experience and knowledge of its working, it must not be at once 
accepted as infallible, or unattended with danger. Cases are on 
record which negative such a claim. For instance, too severe a 
cauterization may be followed by the entire sloughing of some 
portion of the abdominal walls, followed by a large eventration ; 
and peritonitis, tetanus and intestinal fistulse are comphcations 
which have sometimes disappointed hopes which seemed to be 
well founded. 

Animals to which this treatment has been applied must be 
carefuUy watched for some time during the period following the 
cauterization. They must be especially prevented from indulging 
the tendency they often betray — to bite, or scratch vrith their 
feet or legs, the irritated, cauterized surface. A cradle or aprons 
hanging in front of their hind legs, or even bandages may prove 
effectual to prevent this suicidal habit. 

The topical remedies we have mentioned before, might in 
strictness be considered as coming under the head of external 
treatment, since they have all been appHed to the surface of the 
skin. There is, howevor another mode of application which is 
subcutaneous, and which is represented by the method of Dr. 
Luton, and employed in the treatment of the same ailment in 
childi-en. It consists in injecting subcutaneously, at each cardinal 
points of the hernial sac, a few drops of a saturated solution of 
chlorides of sodium (kitchen salt). We have had but one oppor- 
tunity to try the value of this treatment, which we improved by 
injecting ten drops of this solution at each point of a hernial 
tumor. We produced an enormous swelling, followed after several 
weeks by resorption and complete disappearance of the hernia. 
According to Peuch and Toussaint, our friend M. Cagny has 



432 OPERATIONS ON THE DIGESTIVE APPARATUS. 

made the same experiment, but failed to obtain a successful 
result. 

3d. Surgical Operations for the Constriction of the Tumor. — 
Modes of surgical treatment are numerous, usually having in view 
the destruction of the hernial sac, by the process of mortification, 
so controlled and directed as to bring about the necessary work 
of adhesion between the walls of the sac, above the line where the 
mortification begins, with the formation of a secondary cicatriza- 
tion between the edges of the skin, where the mortified sac has 
dropped off. 

Before casting the animal, without which the operation cannot 
be performed, the surgeon must satisfy himself that the hernia is 
reducible, and that there is no adhesion, and should carefully 
measure the dimensions of the sac in order to know accurately 
where the constriction must be applied. The animal must be 
placed well on his back, with his hind quarters elevated — a posi- 
tion which is sometimes sufficient alone to enable the hernia to 
reduce itself. If that fails to occur, the sac can be evacuated by 
the taxis. It is then to be weU stretched, and the application of 
the means of constriction proceeded with. 

These means are many, but may be considered under the three 
heads of the ligature, the clamp and the suture — all of which are 
occasionally combined in use, as the Hgature with the suture, or 
the suture with the clamp. 

(a) The Ligature. — This old mode of operation consists in 
the application — the hernia having been reduced — of a strong 
cord, firmly tied at the base of the hernial pouch. 

The modus operandi is very simple. The hernia being already 
reduced, either by the taxis or by the j)ower of gravitation, as 
before mentioned, and the horse in the right position, on his back, 
the sac is raised from the abdomen, and a strong ligature, firmly 
tightened, is apphed at its base, a strong fishing Hne forming the 
best of ligature for this purpose. The degree of tightness of the 
ligature must be such that the mortification of the sac will be a 
gradual process, and that it does not slip from the walls of the 
sac, on account of the progress of the inflammatory swelling. 
Still this constriction must not be permitted to become so ex- 
treme as to produce too rapid a sloughing of the skin, with the 
possible result of a calamitous eventration. 

In order to prevent the displacement of the ligature, some 



HEBNIA. 433 

practitioners recommend the introduction of two small wooden 
pins just under it, either parallel or crossing each other, through 
the base of the sac. 

If the hernia is very large, instead of employing this mode of 
simple Ugature, en masse, the operator may use two ligatures. 
By pushing through the middle of the sac, close to the abdomen, 
a dog seton-needle, carrying a doubled cord, and converting it 
into two parts in cutting it from the needle, each length will serve 
to embrace half of the tumor, in the manner practiced in the pro- 
cess of removing large, hard tumors by ligature. Legoff has rec- 
ommended the use of several ligatures dipped into ammonia, placed 
one above the other upon the whole length of the sac, from its 
bottom to its base, tightening them more and more as they ap- 
proach the abdomen. By this process he combined constriction 
with cauterization. 

This mode of treating umbilical hernia is a simple and easy 
one, but yet it is not very frequently practiced. The uncertainty 
of its results, the possibility of the sloughing of the skin at too 
early a period, with the danger of eventration, as well as that of 
injuring the intestines with the wooden pins or the needle, have all 
combined to impair its credit and discourage its use among care- 
ful operators. 

(b) Clamp. — In this process, which dispenses with the caustic, 
after the reduction of the hernia, the skin is stretched and pressed 
between the branches of a wooden clamp or of a specially adapted 
forceps. The clamp is a simple implement, and may be made with 
a CTirve, in which case its convexity is made to adapt itself to that 
of the abdomen. When appUed, it is pressed close to the abdom- 
inal walls, and its branches brought together with nippers adhoc, 
and secured with a strong cord, as in the process of castration. 
The clamp is left on from nine to fifteen days. In many cases, 
the displacement of the instrument is prevented by using the 
wooden or metaUic pins passed through the skin below it, the 
ends of the latter being bent over to keep them in place. This 
operation possesses some great advantages, but offers also some 
special dangers, among which is the instinctive tendency of the 
patient to get rid of the irritating appliance by tearing it off. 

Another objection to the clamp is found in the danger of caus- 
ing troublesome excoriations of the sheath by the friction which 
it necessarily occasions. Benkert and Brogniez have advocated 



434 OPEEATIOKS OX THE DIGESTIVE APPAKATUS. 

the use of metallic clamps, but an important objection is found in 
their weight. Borhauer had the branches of the wooden clamp 
perforated in several places for the introduction of the pins which 
held it in place. Bordonnat has invented a special form of me- 
tallic clamp- or rather forceps, with sharp points on the inner bor- 



FiG. 391.— Clamp of Bordonnat. 

der of one of its branches about one-half or three-quarters of an 
inch apart, and in the other a corresponding number of holes into 
which the points are designed to fit when the instrument is closed. 
Each branch has a prolongation at each end, which on one carries 
a vertical projection cut with a screw-thread, while in the other 
there are holes corresponding with the projections, and there are 
nuts to fit the screws. When the instrument is apphed, and the 
projections passed through the holes, the nuts not only hold it 
in place, but are adapted to fix the pressure at any desired point, 
or change it at pleasure. The umbilical forceps of Marlot is 
made of two small wooden plates, slightly curved lengthwise, and 
brought together by means of gooves in their dove-tailed extremi- 
ties, through which screws are fastened. This instrument, like 
the metallic clamps, is objectionable principally on account of 
its weight, and is generally less practical than the ordinary clamp. 

(c) Sutures. — These are of various kinds, aU agreeing, how- 
ever, that the stitches upon which they rely shall be so close and 
tight that the circulation will be so effectually cut off in every 
part of the hernial sac that mortification cannot fail to follow. 

The Quilled Suture. — This consists in placing the sac between 
two small rods of hard wood or metal, and tying them before and 
behind with strong cord tvnsted and rolled around their extremi- 
ties, and also by passing here and there in their length sutures of 
double the strength of those which are apphed in cases of ordi- 
nary quiUed suture. Acting somewhat by pressure, this mode 
much resembles the treatment by the clamp, but is Httle used at 
present, notwithstanding some small advantages which it may be 
thought to possess. 



HEKNIA. 435 

Twisted Sutures. — This consists in applying upon the hernial 
sac several stitches of strong cord in order to keep the reduced 
hernia in statu quo. It is sometimes used in dogs, but is uncer- 
tain and dangerous. 

Suture of Delavigne. — This is another dangerous mode of 
operation, no longer in practice because of the hazard of injury to 
the intestines. It consists in applying a strong double suture at 
the base of the sac in the following manner : With a small needle, 
like that used by harness makers in sewing leather, a thread is 
passed through and through on both sides of the flat, cutaneous 
surface from right to left, or vice versa, then carried back the re- 
verse way at a small distance from the first puncture, and the 
sutures firmly tied. This is repeated until the entire sac is in- 
cluded and the sutures have gone beyond the umbilicus. From 
fifteen to twenty days are said to be sufficient to effect a radical 
cure. 

Method of Mangot. — To make a closing suture on the hernial 
sac, without danger to the intestine, Mangot has recommended 
the use of a perforated plate of lead, by which to aid in the reten- 
tion of the intestines in place and accurately define the line upon 
which the sutures are to be applied. The plate is made to cor- 
respond in dimensions with the opening of the umbilical ring, but 
somewhat longer and wider. Besides the longitudinal slit in its 
center, it also has an eye at each corner for the attachment of 
strings to secure it in place by tying them over the back. The 
hernia being reduced, and the plate put in place by pushing the 
skin of the sac through its longitudinal opening, the operator ap- 
plies a continued suture over and on the outside of the plate to 
keep it in position, with the flap of sewed skin hanging below it, 
the entire apparatus being securely attached to the abdominal 
walls by two pins running through the sac at the extremities of 
the suture. 

During the first days there is much inflammation. About the 
third or fifth day the pins are removed and the skin below the su- 
ture excised, leaving the plate to be retained only by the strings 
which pass over the back. These are sufficient, however, to keep 
it in place, and its removal will not be necessary until inflamma- 
tion is well estabhshed all around them. A simple dressing, held 
in place by a bandage, will help the cicatrization, which is said to 
take place in from seven to eight days. 



43G 



OPERATIONS ON THE DIGESTIVE APPARATUS. 











Method of Ilannon. — The modus 
operandi here indicated does not vary 
from that of Mangot, except in being 
modified by the use of the quilled su- 
ture, as before described, instead of 
employing the transversal pins of Man- 
got. 

Method of Mignon. — This is a com- 
plex mode, consisting of a combination 
of the ligature, the clamp and the suture. 
Like Mangot, he passes the skin through 
a plate of lead, attaches perforated clamps 
on the protruding sac below it, and pass- 
es the stitches or sutures through the 
perforations in the clamps. 

Method of Benard. — This is strictly 
speaking, the application of the crossed 
suture, a stitch exactly resembling that 
of harness and shoemakers in their re- 
spective trades. In making it, a peculiar 
forceps is used, which is apphed like a 
clamp, and serves not only to keep the 
sac closed and secured, but also to pre- 
vent the return of the intestines into its 
cavity, and to assist in guiding the two 
needles with which the suture is made. 
Its branches are at one end articulated 
together, and also at the other in order 
to fit into handles. It is twenty-two cen- 
timeters in length, without including the 
handles ; two centimeters in height, and 
one and a half in thickness. The branch- 
es are brought together tightly by a spe- 
cial screw arrangement near the handles, 
and each has a number of holes, placed 
regularly, one centimeter apart, and uni- 
ted by a groove. Two strong straight 
needles and strong waxed thread are re- 
quired. In operating, the hernia being 
first reduced, the skin is well stretched fig. 392. -Nippers of Benard 



487 



between the brandies of the forceps, then these are tightened by 
the screw management of the handles, and next the instrument 
is committed to the care of an assistant. The crossed suture is 
then made by the simultaneous passage of the needles through 
the holes in the branches of the instrument. The directions to 
insert the needles simultaneously must not be overlooked. If 
disregarded, the penalty hable to follow will be the tearing of the 
waxed thread with the points of the instrument, and also a tang- 
ling of the thread. This method gives a stronger Hgature than 
Mangot's, but it lacks the support furnished by the metaUic plate. 
Method of Marlot. — The methods of Benard and Mangot are 
here combined. A pecuhar thin forceps is used having dotted 
grooves on its outer siu-face to indicate where the stitches are to 




Pig. 393.— Plate and Nippers of Marlow. 



be placed. When the suture is finished and the forceps removed 
a plate of zinc like that of Mangot is appUed, as a means of reten- 
tion, the zinc plate being thought to be an improvement upon that 
of lead, on account of its adapting itself better to the parts. 

Method of Chedhomme. — The animal in this method is kept on 
his feet, jproperly secured, and a plate of lead applied, as in the 
process of Mangot. The hernial sac, folded in two on its longitu- 
dinal axis is then passed through the opening of the plate, the 
operator making the least possible traction until the remaining por- 
tion of the umbiHcal cord, which is still quite large, is firmly held 
between the thumb and the index finger of the right hand. Then 
a stronger traction is made uj)on the sac, at the same time moving 
it in various directions, while w^th the left hand the plate is 
strongly pressed towards the abdominal walls. Then with the 
intestines entirely replaced, the operator grasps the sac with the 



438 OPERATIONS ON THE DIGESTIVE APPARATUS. 

left hand, and with the right, introduces a strong needle which is 
pushed through and through at each extremity of the sac, and 
an elastic Hgature passed three or four times around its base. 
Towards the tenth day the slough is completed, and only a small 
wound remains, which cicatrizes rapidly. 

Direct Suture of the umbilical ring. — Director Degive recom- 
mends for the treatment of umbilical hernia in young dogs, the 
direct interrupted sutures of the ring, the number of stitches 
varying with its dimensions. After bringing the threads together 
the wound is left open until they have safely eliminated themselves. 
We have employed this mode of operation for many years in the 
hospital of the American Veterinary College, using antiseptic pre- 
cautions, and with the best results. Making a longitudinal line 
on the median line of the sac, and having carefully pushed back 
the intestines, the edges of the ring are sewed together with two 
or three stitches of cat gut ligature. The parts were then thor- 
oughly washed with a solution of bichloride of mercury, and the 
edges of the skin brought together with silk sutures and a com- 
pressing bandage appHed for the protection of the wound from the 
patient's own teeth. Complete cicatrization follows in a few days. 

Whatever may be the original mode of treatment the secondary 
effects are about the same in each case. They consist of irritation 
of the parts, more or less marked, and betrayed by the patients by 
varying degrees of restlessness, and jjossibly, in some cases, by 
abdominal pain or cohcs. 

After a few hours the swelling of the part begins. A diffused 
oedema takes place above the point of compression, and the hernial 
sac is sUghtly swollen and warm and becomes covered with Uttle 
phlyctenoids, indicating a commencing necrosis. Perhaps a little 
fever is manifested and there is great thirst. By the third day 
the swelhng is quite large, and in males it may involve the sheath. 
The sac then becomes cooler, the fever subsides, the appetite re- 
turns, and the animal which has instinctively kept his feet, rests 
himself by lying down. On the fourth or fifth day the skin of the 
sac is insensible, cold and flabby, and the sloughing process between 
the Hving and the dead skin has begun. Little by Httle this pro- 
cess becomes more active, and the separation becomes more and 
more marked, the secretion around its opening a purulent character, 
and from the sixth to the tenth day the complete sloughing will 
have taken place. The wound that remains is now granulating. 



HERNIA. 439 

Its length exceeds its width, and it is somewhat depressed in its 
center It progresses rapidly towards cicatrization, only a small 
scar remaining, and this is readily concealed by the growth of the 
surrounding hair. 

{d) Operation in Cases of Complications. — If the hernia is 
irreducible and there is strangulation, the enlargement of the ring 
must be carefully made with a curved, blunt bistoury, having a 
short, guarded sharp edge. When the reduction is prevented by 
adhesions, the operation necessary for their division will demand 
the exercise of the utmost skill and caution to avoid injury of the 
peritoneum, and there should especially be no neglect or parsi- 
mony in respect to the employment of antiseptic precautions. In 
fact, it would in many instances be wiser to leave the animal to 
the resources of nature than to undertake an operation of so much 
delicacy and importance, and which involves so many serious con- 
sequences, without amply providing every resource of skill and 
knowledge, and anticipating every contingency of accident or dan- 
ger. In some cases, when the strangulation has been due to the 
formation of gases in the protruding intestine, we have used the 
aspirator for their removal, and then have met with no difficulty 
in reducing them by the taxis. This is a means, however, which 
is also recommended in the treatment of strangulated ingiiinal 
hernia, and is discussed in the chapter appropriated to operations 
in that region. 

Diaphragmatic Hernia . 

A diaphragmatic hernia, or diaphragmatocele., is formed by the 
displacement of one of the abdominal organs, and its intrusion 
into the pleural cavities, through a laceration of the diaphragm. It 
is necessarily an accidental opening, through which such a dis- 
placement takes place. One case is on record, and only one, 
where the hernia passed through a normal opening, viz., the oeso- 
phageal. 

The causes which give rise to ruptures of this kind may be 
classiiied under three heads : first, external violence ; second, pow- 
erful contraction of the expiratory muscles while making a violent 
effort ; and third, the exertion of force and pressure upon the dia- 
phragm by the organs, situated on its posterior face. 

(a) External Violence. — Foremost in this category are blows 
or contusions on the posterior costal region, such as may be made 



440 OPEBATIONS ON THE DIGESTIVE APPAKATUS. 

by tbe shafts of vehicles with either the blunt or broken ends. 
The laceration of the diaphragm may occur either with or without 
involving the fracture of the ribs. Several cases of this kind have 
been seen and recorded by Professor Barrier. 

(b) The Powerful Contractions of the Expiratory Muscles 
during Violent Muscular Efforts. — It may result from the vio- 
lent and concentrated action of the abdominal muscles, compress- 
ing powerfully the intestinal mass, and crowding it against the 
diaphragm, until it destroys its continuity at one or more points, 
sufficiently to admit of the passage of the abdominal organ into 
the thoracic cavity. Durand has seen it in a six-months-old colt ; 
Didry and Fabey have reported cases where the hernia took place 
during violent efforts in hauhng a load, and Franconi met with a 
case of a similar character to the one referred to in which the rup- 
ture opened into the oesophagus. Schild has seen it associated 
with the efforts of parturition. 

(c) Violent Action and Pressure upon the Diaphragm by the 
Organs Situated on its Poslerior Face. — The obhquity, forward 
and downward, of the inferior plane of the abdomen, is shared 
forward upon the posterior face of the diaphragm by the organs 
related to it, as the liver, the stomach and the anterior curvatures 
of the large colon. These are bulky organs, and their united 
weight being very considerable, the pressure it exerts upon the 
diaphragm, under any extra impulse would tend directly and nat- 
urally to the disruption of the weaker muscular fibres of the 
midriff, and these yielding, the hernia would immediately become 
developed, and thus we have the generation of this kind of hernia. 
A sudden fall might easily bring this to pass, in a second or two 
of time. Bouley has recorded a case in which this accident oc- 
cured in an animal cast for a surgical operation. Pilton has seen 
it take place in an animal falling down while butting against a 
slope of ground. 

Diaphragmatic hernias, like others, are either acute or chronic ; 
or convertibly, recent and free, or of old standing, with adhesions. 
The distinctions of hepatocele, splenocele, stomachocele and entero- 
cele are of but httle importance, none of these differences being 
discoverable in the living animal. 

The symptoms of acute hernia of the diaphragm differ, accord- 
ing to the extent of the laceration of the muscle, and the size of 
the displaced abdominal mass. There are cases in which the in- 



HEENIA. 441 

jury is of so aggravated a character from the first, that a fatal 
result immediately follows the formation of the hernia, the only 
characteristic symptoms present being those of rapid asphyxia. 
In other cases, though death must inevitably follow, the life of 
the animal may be prolonged for several hours, or even several 
days. And again, there are recent hernias which have been formed 
under such conditions that they are still compatible with the sur- 
vival of the animal. These assume the chronic character, and not 
infrequently escape discovery. 

The horse affected with diaphragmatic hernia becomes dull, 
anxious and uneasy, avoiding his manger and avoiding his food. 
He paws in the stall, giving evidence of suffering from abdominal 
pains, but which betray no pecuHar characteristics, and possess 
no special or positive significance. Very often coUcs precede 
the hernia, and its formation compHcating the case, the coHcs be- 
come more violent. During these coHcs the animal hesitatingly 
and carefully lies down, rolls much, and assumes various attitudes 
of no special significance, though the dog-sitting posture is some- 
times held to be characteristic. During these colics, which are 
more persistent than those due to intestinal indigestion, the pulse 
remain strong and quite regular, and respiration is not only ac- 
celerated, but difficult — the physiognomy is anxious, with an ex- 
pression of apprehended suffocation, the nostrils are tetanically 
dilated, inspiratory movements are performed with effort, and 
expiration is of twice or three times its normal frequency. The 
coexistence of this condition of the respiration with the colics is 
a sign of great importance as an element of the diagnosis. At 
times auscultation furnishes valuable data. Borborygmus may be 
detected in the thorax, where the respiratory murmur ought to 
be heard, and dullness on percussion takes the place of the nor- 
mal resonance, where the respiratory murmur has disappeared. 

Bouley, though he recommends this means of diagnosticating, 
considers it to be applicable only for hernias of large size, in which, 
according to Lafosse, an increase in the size of the thorax, a well 
marked projection of the cai'tilaginous circle of the ribs, and to- 
gether with these, a reduction in the size of the abdomen wovild be 
noticed. When the hernia is small, the respiratory function is 
imaltered. 

Acute diaphragmatic hernias, not necessarily of fatal tendency, 
are more difficiilt to detect. Probably from their rareness they 



442 OPERATIONS ON THE DIGESTIA'E APPARATUS. 

often escape discovery, notwithstanding a somewhat positive exhi- 
bition of abdonunal and thoracic symptoms. And if this is so 
with the acute form, it must necessarily more frequently occur with 
chronic cases, which not only do not jeopardise life, but even fail 
to interfere with the usefulness of the animal. The horse thus 
affected not only has the double expiration of his emphysematous 
lungs, but he continues to be subject to intermittent cohcs, and 
especially if the hernia is formed by the intestines, and they con- 
tinue to suffer from occasional obstructions. To this complication 
of occasional actual obstruction must be added a perpetual Hability 
to become strangulated, with a certainty of speedy death following 
that accident. 

The lesions found at the post-mortem examinations of ani- 
mals which have died with this description of hernia varies. The 
accidental diaphragmatic openings may exist in different parts 
of the central aponeurotic portion or in the peripherical muscular 
zone, and may assume various forms, being at one time round, at 
another eliptic or triangular, or indefinite and irregular, at times 
very narrow, at others so extensive that the abdominal and thoracic 
cavities are no longer distinct. Between these two extremes there 
are many degrees and ample scope for the formation of chronic 
hernias of a non-malignant character. When the hernia is recent 
and has existed before death, the borders of the laceration whether 
muscular or aponeurotic, are irregular, thready, infiltrated and 
bloody, with small blackish clots adhering to the extremities of 
the red muscular fibres. But when the rupture is of post-mortem 
formation, resulting from excessive meteorism, there is no trace of 
capillary hemorrhage upon the lacerated edges of the aperture. 

With a chronic hernia these edges have various aspects; at 
times thin, at others in thick cords ; now torn in scallops, and 
again with a regular edge, they are always smooth, hard, of fibrous 
consistency, and even presenting a cartilaginous aspect. There is 
never any formation of a special serous sac for these hernias, even 
for those which take place through the normal openings. The 
organs most commonly met in these diaphragmatoceles are the 
omentum, the small intestines, the anterior curvature of the large 
colon, and more rarely, the spleen and the stomach. If not con- 
gested by pressure in passing through the opening, they continue 
to perform their functions. 

In these injuries the prognosis can never be confidently favor- 



HERNIA. 443 

able. It is always serious. Some kill immediately, while with 
others there may be a respite of several hours or days, and with 
those which are chronic, there may be no apparent impairment of 
life or health. But whatever may be the character or the aspect 
of a given case, and however the prognosis may vary, it must 
never be forgotten that diaphragmatic hernia has this invariable 
character, that its effect is always to interfere with the respiration ; 
that the horse is at the best permanently affected with heaves, is 
unable to perform any active or laborious service where strong 
lungs are needed, and is always more or less liable to engorgement 
and strangulation. Diaphragmatic hernias are incurable, their sit- 
uation, in the deepest interior of the anatomy, rendering it impos- 
sible to apply any means of direct therapeutic treatment. They 
cannot be reduced, and even if that were practicable, they could 
not be secured and retained in situ. Attempts have been recom- 
mended by Bouley to reduce them by making an incision through 
the flank and replacing the protruding organ in its proper posi- 
tion by the taxis with the hand in the abdominal cavity. Whether 
in our days of perfect antiseptics such an operation could be suc- 
cessfully performed on the horse is a question not yet solved. The 
experiment might be attempted with better chances of success in 
cattle. In any case the operation will be justifiable only as a 
last resource, and when the life of the suffering animal is abso- 
lutely in jeopardy, in fact, as a final alternative, a dernier resort. 

Ventral Hernia. 

This term includes all hernial tumors produced by the pro- 
trusion of one or several of the abdominal organs through an ac- 
cidental opening in the muscular and fibrous walls of the abdomen, 
under the skin, which remains intact. The opening through which 
this kind of rupture takes place is always accidental, unlike those 
which pass through the natural channels, as the umbiHcal or in- 
guinal, but still, in common with them, has a peritoneal lining. 

Ventral hernias are of quite common occurrence, principally 
however, in large animals, while in small quadrupeds they occur 
less frequently, and they may take place in any part of the abdo- 
men. They are known by distinctive names, corresponding with 
those of the protruding organ, as gastrocele, hepatocele, enterocele 
and epiploocele, etc. 

They usually originate as direct causes in blows or contusion 



444 



OPERATIONS ON THE DIGESTIVE APPARATUS. 




Fig. 394.— Ventral Hernia. 

upon the abdominal walls, made by blunt bodies, vehicli, lacking 
force to pierce throug-h. the elastic skin, are yet sufficient to lace- 
rate the interior abdominal walls. An example of this occurs in a 
thrust from the shaft of a vehicle, or its broken end, in case of 
a faU, or of kicks or horning among cattle in the field. In colts 
they are more commonly found in the lower wall of the abdomen, 
the animal frequently inflicting them upon itself by attempting too 
high a jump over a picket fence, and failing to clear it properly. 
Serres says that in cattle they may follow a severe distension of 
the abdomen under the influence of tympanitis, abdominal dropsy, 
or gestation. 

The character of a case of ventral hernia will vary in respect 
to its being acute and recent, or chronic and old. Indeed, the 
lapse of but a few hours will materially change its character from 
one to the other. If seen immediately after the infliction of the 



HERNIA. 445 

injury, it is in the form of a round, soft, elastic tumor, well- 
defined in its outlines, and easily reducible. But if not examined 
until after a season of delay, the definite configuration disappears, 
and it is changed into an inflammatory swelHng, oedematous, warm 
and painful to pressure — in fact having the aspect of a warm ab- 
scess. In the recent cases, the edges of the torn abdominal walls 
may be identified through the thickness of the skin, but the sur- 
geon will vainly try to make out this condition if the inflamma- 
tory process following the lesion has become established, and the 
serosity and the blood have become sufficiently infiltrated into the 
cellular tissue to make the change described. After a few days, 
if the hernia is not situated too low in the abdomen, the swelling 
moves downward toward a more dependent spot, and gradually 
abating disappears in about two weeks. Upon reaching this 
point, the hernial tumor is once more recognized, constituting, as 
it does, the exclusive manifestation of the displacement of the in- 
testinal mass, and its presence outside of its natural cavity. It is 
recognized by its changing conditions — elastic when the intestine 
is empty ; soft and puffy during digestion ; by its state of tension, 
increasing with effort, and by being painless, depressible and re- 
ducible. T\Tien reduced, the edges of the opening are easily 
made out, but it is not uncommonly found, upon the subsidence 
of the inflammatory process, that, during the continuance of that 
state, adhesions of the protruding organ with the walls of the 
sac have formed, and the hernia has become irreducible. In their 
dimensions, ventral hernias vary considerably. They may measure 
from the size of a large nut to that of a man's head, or even exceed 
that. Zundel reports a case where the rumen had penetrated into 
the sac, which hung almost to the ground, and had produced a dis- 
placement of the mammffi, crowding them in a mass toward the 
right side of the abdomen. 

Although the diagnosis of ventral hernia is not difficult, it is 
still not impossible to mistake a recent case for certain other affec- 
tions of the abdominal walls, such as tumors of bacterian anthrax, 
or those of a bloody nature, or with phlegmonous or oedematous 
growths. The reducibility and elasticity of the tumor, the bor- 
borygmus, and the presence of the opening through the abdomi- 
nal walls, are intelligible signs by which to recognize the ventral 
hernia. Aspiration of the tumor may sometimes be performed, 
and rectal examination will also be of great assistance provided 



446 OPERATIONS ON THE DIGESTIVE APPARATUS. 

the iBJury is not beyond the reach of exploration with the hand. 

Certain complications are not uncommon in ventral hernia. 
Besides irreducihility already mentioned, excessive inflammation 
has sometimes been followed by traumatic peritonitis. Lacera- 
tions of the displaced organs have proved fatal. Internal hemor- 
rhages, fistulas and consecutive eventration have also been record- 
ed. Strangulation is not unknown, though it is comparatively 
rare. 

But with all these possibilities, it is not a rare circumstance to 
meet with animals affected with ventral hernia, even of large di- 
mensions, which have reached a good age with all the appearance 
of perfect health. From data like these upon which to found a 
judgment, it ought not to be difficult to deduce a prognosis which 
should never be far wrong. But, although compatible with the 
life, health and utilization of the animal, such a lesion must neces- 
sarily detract more or less from its commercial value. Under 
any circumstances, it is a blemish. The least dangerous of this 
class of ruptures are those which are situated on an elevated point 
of the abdomen. Recent and uncompHcated, they are amenable 
to treatment more or less, according to their extent ; if old or 
chronic, the chances of success are reduced ; if strangulated, they 
are generally fatal. Usually, a ventral hernia, to be curable, 
must be treated when it is recent, and before sufficient time has 
elapsed for the intestines to become, as it were, accommodated to 
their new position, and especially before the cicatrization of the 
borders of the lacerated openings has taken place. Recent and 
free from complications, all that is required is their reduction 
and retention in their proper place. 

When reduced, whether by rectal taxis or by external pres- 
sure, the parts are covered with a mixture of pitch and Venice 
turpentine melted together, upon which is spread oakum cut in 
small, short threads, which is to be covered with a second appli- 
cation of the pitch, after which a sheet of pasteboard, itself also 
impregnated with the pitch mixture, is placed over the opening. 
The whole is then covered and held in place by a broad bandage 
carefully rolled around the abdomen. Leather is sometimes used 
in Heu of the pasteboard. This bandage, when applied upon male 
bovines, requires to be carefully adapted in order to avoid any 
possible interference with the penis, and its freedom of motion in 
the act of micturition. The complications of swelling or bloody 



HERNIA. 447 

extravasations must not prevent the immediate application of the 
bandage. 

In cases of chronic hernia, compression is no longer sufficient. 
Jannet recommends the use of clamps as in umbihcal hernia, and 
reports having reUeved a case where the tumor was as large as a 
child's head. Leblanc advises the quiUed suture, and Schwane- 
feld cured by this mode a hernia twice as large as the head of a 
man. Hertwig speaks favorably of the application of Delavigne's 
method in exomphalus. Going, Lafosse and Hertwig have ob- 
tained success with nitric acid injections, and Krantz and Schutt 
with blisters. Peyon, Dandrieu, Terrien and Obich have had 
good results with the direct suture of the ventral waUs in bovines, 
and even solipeds. Bouley objects to the suture of the edges of 
the opening, and also to injections into the evacuated sac of irri- 
tating substances, to excite inflammation and produce the adhe- 
sion of its walls. We have ourselves experimented several times 
with the subcutaneous injections, but every attempt has resulted 
in failure. According to Peuch & Toussaint, if old ventral her- 
nias are to be treated, the best plan is to have recourse to bandag- 
ing, as employed in the treatment of exomphalus. 

EVENTRATIONS. 

An eventration may be defined as a compound hernia, and it 
constitutes an accident of the first degree of severity, consisting 
in the formation of a hernia, of indefinite dimensions, taking place 
through an opening involving the entire thickness of the abdomi- 
nal walls, the skin included, in such a manner that some portion 
of the abdominal viscera, but most commonly the intestines or the 
omentum, become directly exposed. Ordinarily they are due to 
some traumatic lesion, such as a thrust from or a fall upon a sharp 
body, or they may be produced by stab wounds, or pvmctures with 
a fork or a knife ; or again, by kicks inflicted by other animals, or 
horn-blows, when cattle are crowded into too contracted a space 
and struggle for more room, or quarrel when herded in pastures. 
And they quite commonly end the career of the wretched victims 
of barbarity which are compelled to assist in the bloody and cruel 
sport of the Spanish buU. fight. They are also observed at times 
following severe surgical manipulations, as in castration, during 
the operation for strangulated inguinal hernia, after the efforts of 



448 OPERATIONS ON THE DIGESTIVE APPARATUS. 

distokia. They may also form one of the complications of some 
of the forms of the treatment of umbHical hernia. In the 
smaller animals, such as dogs, they may be produced by a severe 
bite by a larger animal. 

The pathognomonic symptom of an eventration may be con- 
sidered the protrusion of a portion of the abdominal contents 
through its lacerated walls. If the opening through which this 
takes place is small, the viscera will appear as a small round tumor, 
which presently becomes transformed into a large mass of intes- 
tinal circumvolution, which itself varies in dimensions, according 
to the extent of the laceration. As the exposed intestines begin 
to protrude, they for a period retain their physiological appear- 
ance and normal color, but they undergo rapid changes, becoming 
progressively darker, blueish and then black, and grow cool to the 
touch. The viscera as they protrude from the abdomen may be 
quite intact, but they often are injured, bruised or torn, the con- 
ditions varying according to the peculiar circumstances attending 
the accident. And not only is this so, but the sequel of the case 
must be especially considered, since an eventration which possibly 
might be susceptible of cure, if carefuUy tended from the first, 
may become so aggravated and exaggerated as to preclude aU 
possibility of remedy, as when the wounded creatiire, frantic with 
pain, from colics and otherwise, in rearing and struggling, forces 
his entrails more and more out of their place, and tears and tram- 
ples them upon the earth until they become a mere mass of crushed 
and bruised viscera, ground into the earth. And yet, colics are 
not always present in eventrations, even in horses whose irritable 
temper, combined with the condition of the injured j)arts, would 
naturally tend to render their occurrence quite inevitable. 

The prognosis of their injuries varies according to the species 
of the animal, and also under the special condition and circum- 
stances of each case, as judged by itself. In horses, it is, in the 
majority of cases, a fatal accident. The sensitiveness of the animal 
to impressions upon the nerves, and the delicate susceptibihty of 
the peritoneum account for this. In ruminants they are less 
serious, and certainly still less so in carnivorous animals, where 
sometimes the whole intestinal mass may be seen hanging through 
the laceration, and with extensive co-existing inflammation, with- 
out the occurrence of a fatal termination. 

Swine are also very sensitive to this kind of injury, though the 



EVENTEATIONS. 449 

prognosis may vary with them, according to the condition of the 
lesion, being more or less favorable according as the bulk of the 
proti'uding viscera is less or greater. The chances of recovery 
will also vary in the ratio of the degree of the exposui'e of the vis- 
ceral organs to the atmospheric aii', or to the severity of any 
traumatic accidents they may have encountered. 

The indications of treatment suggested in these cases is obvious. 
The first is always, when practicable, reduction. To return the 
intestine to the situation designed by nature for its occupancy is 
the first step to take. If it has not been seriously wounded, and 
is in a state of cleanliness, and has escaped contact with the earth 
and other soils and stains, simple washing may be attended to at 
once. But if, on the contrary, it is bruised, soiled and inflamed, 
it must be carefully cleansed with warm water, before being re- 
turned to its position. This reduction must be carefully per- 
formed by the taxis, and if the opening of the abdomen is too small 
to allow this to be accomplished with facility, it will be good prac- 
tice to enlarge the opening with the knife, rather than to hazard 
the too free manipulation of the tender parts which will form the 
dangerous alternative which may become the exciting causes of 
consecutive inflammatory, and perhaps gangrenous sequelae. If 
instead of the intestines the eventration allows the exit of the 
omentum, this also must be cleaned and washed, if necessary, and 
returned, though in some instances it may be torn or cut off after 
ligating its large blood vessels, or better yet, Hgating the whole 
mass with animal ligature. The second step of the operation con- 
sists in applying means of restraint to retain the retiu-ned organ 
and prevent a second exit. The quilled suture is at this jnnctui'e 
the means which always first suggests itself to the surgeon's mind. 
The clamps have their advocates, but Zundel prefers the metaUic 
interrupted sutures. The entire application is to be supported, 
reenforced and j)rotected by a wide bandage, similar to some of 
those recommended in umbilical hernia. 

LAPAROTOMY. 

This operation, which consists in the opening of the abdominal 
cavity thi-ough the loins or flanks, is one which, considering the 
general indication for which it is performed in human surgery, 
has found but little appUcation and occupies but a smaU place in 



450 OPEEATIONS ON THE DIGESTIVE APPAKATUS. 

veterinary practice. According to Director Degives, who furnishes 
the only description of the operation to which we have been able 
to obtain access, the indication for laparotomy occurs in cases of 
intestinal invagination, internal hernia and intestinal strangulation 
and for the removal of foreign bodies from the abdominal cavity 
or the intestinal tract. 

Once a celebrated surgeon of New York had decided to prac- 
tice it upon one of his valuable dogs, which was suffering with 
impaction caused by the lodgement of a mass of hair in the intes- 
tines, which we fortunately succeeded in softening and removing 
by internal treatment. The indications for the operation are im- 
perative as soon as a fatal result becomes imminent and certain. 
The instruments necessary are a convex bistoury and suture needles. 

Dr. Degives briefly describes the operation as follows : " I*osi- 
tion and Restraint of the animal standing up, or in stocks, or 
resting against a wall or its equivalent. If the animal is restless 
let him be thrown down on the side opposite to that of the opera- 
tion, which is divided into three steps. 

First Step, opening of the fianh. — The abdominal opening 
must be in the ujjper part of the flank, upon a line between the 
hip and the last rib. This opening may be made in two ways : 

1st, or Simple Method. — It consists in making an incision 
through the various anatomical layers, in the same direction, in 
order to form a simple vertical wound, large enough to admit the 
hand. The parts having been shaved, the division of the skin, the 
abdominal muscles and the peritoneum is made successively with 
the convex bistoury. The incision of the deep layers alone pre- 
sents any difficulty, and this requires some attention, the hemor- 
rhage being sometimes troublesome ; but when the peritoneum is 
exposed, the incision is increased, from without inward, with 
either a blunt bistoury or the straight bistoury controlled by a 
grooved director, an assistant protecting the intestines from the 
contact of the instrument. 

2d, or JSfew Method, by Complex Incision. — In this each mus- 
cle is divided in the direction of its own proper fibres. Thus, 
the first is a transverse, cutaneous incision ; second, three muscu- 
lar divisions, running in directions more or less opposed to each 
other ; the first, obliquely downward and backward ; the second, 
obliquely forward and downward, and the third transversal and 
parallel to that of the skin. These incisions are very easily made, 



LAPAROTOMY. 451 

little more being necessary than a simple laceration of the intesti- 
nal tissue with the fingers — there is Httle or no hemorrhage. The 
opening thus made admits the hand into the abdomen, and when 
it is removed the fibres of each muscle having a tendency to come 
together spontaneously, the opening is more or less eff"ectually 
closed. 

Second step. — This varies, to correspond with the object of the 
operation ; 1st, whether the extraction of a foreign body in the 
abdomen or intestines, or 2d, the reduction of an invagination or 
of an internal hernia (diaphragmatic, mesentoric, epiploic, or pan- 
creatic), and, 3d, the displacement or removal of a tumor involving 
the intestines. 

In the reduction of an internal hernia, it may be necessary 
either to pull or to push upon the displaced organ. In some cases 
the hernial ring must be enlarged, and if that cannot be done with 
the fingers, the bistoury must be used. The reduction of an intes- 
tinal invagination is obtained by the combined action of a slight 
traction on the invaginated part and a steady external pressiu-e 
upon the enlargement formed by it in the portion of the intestines 
in which it is enfolded. When the sweUing of the organs or the 
presence of abnormal adhesions prevent the reduction, the traction 
must be increased and in opposite directions — the invaginated por- 
tion in one, the enfolded portion in the opposite. 

If a stone, a calcvdus, or any foreign body is to be extracted, 
the intestine is to be incised at some distance from the insertion 
of the mesentery, on its lateral face, between the two curvatiu'es. 
On the removal of the body the intestinal suture is to be appHed. 

Third step, Closing the Parietal Wound. — "When the complex 
incision has been made, a strong cutaneous suture is all that is re- 
quired. When the di\ision has been a simple one, the edges of 
the muscular wound are brought together by ordinary interrupted 
sutures, and the skin is afterward sewed up. The drainage at 
the lower part of the wound is always advantageous." 

As enteritis and peritonitis are common sequelae of this opera- 
tion much care and watchfulness devolve on the surgeon in direct- 
ing the regimen and nursing of the patient in order to prevent the 
possibility of their access from becoming a certainty. 



CHAPTER IX. 

OPERATIONS ON THE RESPIRATORY 
APPARATUS. 

ON THE GUTTUEAL POUCHES— HYOVERTEBROTOMY. 

TMs term fails to meet the approval of Zundel, who has pro- 
posed that of Hyospondylotomy as a substitute, in order the better 
to indicate the puncture of the sac of the guttural pouches which 
it signifies. The former name, however, has been generally ac- 
cepted, and while its etymology would point to the operation by 
which the puncture referred to is made between the hyoid bone 
and the atlas, it is stiU used to mean generally, the puncture of 
the pouches, at whatever point it may be made. 

These guttural pouches, which exist exclusively in the sohpeds, 
and are two in number, are situated between the cranium, the 
pharynx and the atlas, resting upon each other on the median 
line, each one, by an expansion of the mucous membrane of the 
Eustachian tubes, forming a sac and fiUing the triangular space 
situated posterior to the pharynx and extending to the larynx. The 
mucous membrane which forms them is easily stretched, and the 
cavity may thus become greatly distended by the accumulation of 
pus, and when this is the case, the pouch extends below the larynx 
and the lower extremity of that organ. Thus situated in the parotid 
region, these two sacs sustain important relations to other points, 
varying according to the position, whether of extension or flexion, 
of the head ujjon the neck, and are covered by seven separate 
tissues, as represented in their order from without inward, by 
1st, the skin ; 2d, a layer of subcutaneous connective tissue, more 
or less abundant ; 3d, a thin expansion of cutaneous muscle with 
the parotido-auricularis muscle ; 4th, the parotid gland, whose 
internal face is moulded upon the muscles and blood vessels un- 
derneath ; 5th, the following muscles in the order as named from 
above downward, viz., the small obHque of the head — the stylo- 
hyoideus, which fills the space left between the anterior border of 



HYOVEKTEBKOTOMY. 



453 




Fig. 395.— Antero-PoBterior Section of the Head, showing the Mouth, Fances, 
and Nasal Cavities. 

1, genio-glossus mascle; 2, genio-hyoideus muscle; 3, the velum palati; 4, pharyn- 
geal cavity; 5, oesophagus; 6, guttural pouches; 7, pharyngeal opening of the Eustach- 
ian tube; 8, laryngeal cavity; 9, lateral ventricle of the larynx; 10, trachea; 11, ethmoi- 
dal turbinated; 12, maxillary turbinated; 13, ethmoidal volutes; 14, cerebral compart- 
ment of the cranian cavity; 15, cerebellar compartment of the same; 16, falx cerebri; 
17, tentorium cerebelli; 18, superior lip; 19, Inferior lip. 

the styloid process of the occipital bone and the superior border 
of the long branch of the hyoid, through which the puncture is 
made in order to enter the guttural pouches, and back of this the 
stylo-hyoideus and the superior border of the digastricus ; then, 
6th, on the deejDest layer, the guttural pouches are found supe- 
riorly, resting intimately on the internal face of the stylo-hyoideus 
muscle, inferiorly closely cemented with the posterior face of the 
pharynx and posteriorly with the superior extremity of the long 
muscle of the neck ; and 7th, the numerous and important blood 
vessels and nerves belonging to the parotid region. 



454 



OPEKATIONS ON THE KESPIKATORY APPARATUS. 




Pig. 397.— Parotid Region— Superficial Layer. 
PP, parotid gland; Mpa, parotldo-auricular muscle; 3, transveral artery of the face; 
4, maxillo-muscular vein ; 7, jugular vein ; 8, glosso-f aclal vein ; 9, transversal vein of 
the face; 10, maxillo-muscular vein; 12, posterior auricular vein; 13, facial nerve; 
15, auricular branch of the 2d cervical pair. 

The arteries are the three divisions of the primitive carotid ; 
1st, the occipital, which, by its mastoid branch, runs over the ex- 
ternal surface of the styloid process of the occipital bone ; 2d, the 
internal carotid, which runs upward through the thickness of the 
fold of the mucous membrane which forms the guttural sacs ; 3d, 
the external carotid, with its parotid branches, the maxillo-mus- 
cular, the posterior auricular, the superficial temporal trunk and 
the internal maxillary. The veins, which are numerous, empty 



HYOVEKTEBKOTOMY. 



455 




Fig. 397.— Parotid Region— Middle Layer. 

P, parotid gland; D, digastricus muscle; Sh, occipito, or stylo-hyoideus, muscle ; 
Sm, sterno-maxillaris muscle; P, thyroid gland; H, posterior border of the great 
branch of the hyoid bone; 1, primitive carotid artery; 2, external carotid artery; 
3, transversal artery of the face; 4, maxillo-muscular artery; 5, posterior auricular 
artery; 6, thyro-laryngeal artery; 7, jugular vein ; 8, glosso-facial vein ; 9, transversal 
vein of the face; 10, maxillo-muscular vein; 11, anterior auricular vein ; 12, posterior 
auricular vein; 13, facial nerves ; 14, anterior auricular nerve. 

into the jugular or its different branclies. The principal nerves 
of the parotid region are the facial, the pneumogastric, the spinal, 
the superior cervical ganglion of the sympathetic, the great hypo- 
glossus and the glosso-pharyngeal. These nerves, with the exception 
of the facial, are situated on the external face of the pouches below 
the long branch of the hyoid bone and the stylo-hyoideus. 



456 OPERATIONS ON THE RESPIRATORY APPARATUS. 

This rapid smnmary of the anatomy of the parotid region will 
sufficiently indicate the dangers which the surgeon is likely to 
encounter at successive steps of the operation, and especially if 
he duly considers the location of the occipito-hyoideus, which must 
be reached before the puncture can be made, and again, the pecu- 
liar course followed by the posterior auricular artery as it emerges 
from the parotid to reach its destination. 

Hyovertebrotomy is indicated in all cases of repletion of the 
guttural pouches resulting from a purulent collection and main- 
tained by a process of chronic inflammation. It is principally 
when horses have become liable to be attacked with strangles that 
these purulent collections are formed. They are marked by an 
increase of size in the pouches, gradually augmenting with the 
continued formation of the pus, and interfering more and more 
with deglutition and respiration, sometimes assuming such pro- 
porfei^as as even to threaten suffocation. Attacks of pharyngitis 
or laryngitis, or catarrh of the anterior chambers of the respira- 
tory apparatus and nasal cavities, or sinuses, are at times noticed 
in connection with this affection. 

To revert to the anatomical arrangement of the parts : The 
guttural pouches, opening into the cavity of the pharynx by a 
narrow sHt, are situated on the lateral surface, and thus allow any 
collection of pus they may contain to flow without interruption 
into the pharynx, and hence into the other nasal cavities. We 
have here an explanation of the fact that a discharge from the nose 
in any one of a variety of affections, such as suppuration of the 
guttural pouches, pharyngitis, laryngitis, catarrh, and also the dis- 
charo-e of glanders, may all possess different characteristics, and 
each exhibit a different aspect, and therefore demand a different 
diagnosis and require different treatment. 

The discharge from the guttural pouches is whitish, glairy, more 
or less mixed with mucosities, inodorous, non-adhesive to the wing 
of the nose, and intermittent, being marked during mastication 
or deglutition, and especially while swallowing liquids — in all form- 
ing an assemblage of characteristics which should be sufficient to 
distinguish the affection from all others. There is, besides this, a 
negative point, in the absence of chancres, which with the distinct 
nature and pecuharity of the discharge, and the characters so 
typical of the maxillary lymphatic glands in that disease, will 
largely aid in determining the difference between the two affections. 



HYOVEETEBEOTOMY. 457 

In respect to glanders, moreover, the bad odor, the thick, gru- 
mous nasal discharge, and the soreness and dullness on percussion 
of certain parts of the face, will in many cases serve to identify 
and distinguish a pathological condition of the sinuses ver}'^ dif- 
ferent from that of the disease we are considering. Gohier and 
Vatel also refer to guttural tympanitis, or dilatation of the pouches 
by air, as a feature of their disordered condition. The amount of 
pus collected in the pouches varies in different cases to such an 
extent that from only a trifling degree of dilatation it may be suf- 
ficiently extensive to produce a sensible projection of the sac below 
the parotid. This dilation furnishes a guide for the determination 
of the proper point at which to make the puncture, whether in the 
upper, in the middle, or in the lower part of the pouches. The 
upper operation is hyovertebrotomy proper. Besides these three 
modes of operation, Gunther has proposed a fourth method which 
consists in penetrating the pouches through the nasal cavities. 

Upiyer operation — Hyovertebrotomy proper. — As described by 
Chabert and Fromage de Feugre, this is one of the finest and most 
dehcate operations of veterinary svirgery. Extremely so when per- 
foi'med on horses whose pouches are healthy and normal in size, 
it loses a great deal of its apparent difficulty when these are full of 
pus with prominent and well developed walls. The nerves and 
blood vessels which surround them are then easily pushed aside 
from theu' position, and the lobules of the parotid are more or less 
separated. 

The instruments required for this operation are: a pair of 
scissors, a convex and a straight bistoury, a dissecting forceps, an 




Fig. 398.— Curved Trocar, or Hyovertebrotome. 

S probe, or preferably, the curved trocar, the hyovertebrotome 
(Fig. 398), and a piece of tape. Artery forceps and ligatures 
ought to be always within reach. 

BoTiley, Zundel and others recommend that the animal should 
be kept in the standing position with simply a twitch on the lip, 



458 OPEKATIONS ON THE EESPIRATOKY APPARATUS. 

but our experience lias tauglit us that the recumbent position is 
the safest, especially if there are plenty of assistants at hand, with 
instructions to keep the head of the animal steady, and in a mode- 
rate state of extension on the neck. 

The operation is divided into three steps; 1st, The incision of 
the skin and dissection of the parotid ; 2d, The puncture of the 
pouch through the occipito-hyoideus muscle ; and 3d, The estab- 
lishment of the counter-opening. 

Before considering these three steps, it will be well to answer 
sundry important questions put by Lecoq in the first good de- 
scription of the operation, made in 1841. 

IVhere shall the p>uncture he made? 

The anatomical disposition, which we have already examined, 
suggests as an answer to this query, that the occipito-hyoideus 
muscle is the proper place for the puncture. Its inner side is 
lined with the mucous membrane of the pouches, and as has al- 
ready been remarked, when this is distended by fluid and becomes 
tense and resisting, it is in a much better condition for the pass- 
age of the knife through its thickness than when flabby and soft, 
and therefore movable and shifting, as if endeavoring to evade the 
knife. At any other point the pouches are so surrounded by im- 
portant blood vessels and nerves that the operation is precluded 
by the danger which would be incurred by attempting it. 

Where must the first incision he m,ade to reach the occipito- 
hyoideus muscle? 

It would be easy to reach the muscle by a division of the paro- 
tid gland, but this would involve the formation of a fistula, and a 
wound difficult to heal, to avoid which the gland must be raised 
out of the way. This should be done by raising the posterior bor- 
der, where it is loose and free from blood vessels or nerves of 
importance, in preference to doing so by disturbing the anterior 
border or superior extremity, where the posterior auricular artery, 
the facial nerve and the sub-zygomatic artery are situated. The 
superior extremity of the incision must begin near the inferior 
border of the tendon common to the splenius and small com- 
plexus muscles, a little in front of the transverse border of the 
atlas, and extend downward for a space of two or three inches. 
Upon v^hat point of the muscle must the puncture he made? 

The answer to this is — upon the central portion of the muscle. 
The introduction of the bistoury into the superior part of the 



HYOVERTEBKOTOMY. 459 

muscle will involve possible danger to the posterior auricular ar- 
tery, and the risk of the di\ision of the facial nerve. 

In what direction must the sharp edge of the bistoury he 
turned? 

The reply to this is the point of minimimi danger from irregu- 
lar motions of the instrument, caused by the struggling of the 
patient ; and this result is most likely to be accomplished by carry- 
ing the bistoury towards the tuberosity of the hyoid bone, and 
consequently in the direction of the patient's nose. With the 
instrument turned towards the ear, there would be possible dan- 
ger of dividing the posterior auricular artery, the facial nerve or, 
perhaps, the internal carotid. 

In carrjdng it toward the atlas, the internal carotid, and the 
nerves surrounding it, would be the endangered parts, if any. If 
directed downward, toward the larjoix, a division of the great hy- 
poglossus, and possibly of the external carotid, might be possible. 

"What must he the direction of the instrument? 

If the bistoury is pushed through the occipito-hyoideus muscle, 
and in a direction perpendicular to it, there will be great danger, 
at a certain depth, of reaching and penetrating through the in- 
ternal carotid artery ; but if an obHque direction be given to the 
instrument, not only is this danger avoided, but no accident be- 
yond some slight muscular injury, of no importance, need be ap- 
prehended. 

Where is the counter-opening to be made ? 

The right place wiU be the most dependent parr of the pouches, 
and the instrument used must be either the S probe or the trocai*, 
as wiU be hereafter described. 

These preliminary points being understood, we shall the more 
inteUigently foUow the description of the three steps of the opera- 
tion, which we now proceed to give. 

1st. The Incision of the Skin and Dissection of the Posterior 
Border of the Parotid. — This incision is made a little in front of 
the transverse process of the atlas. It includes the skin and some 
subcutaneous aponeiu'otic fibres, and extends to the posterior bor- 
der of the parotid, which is at this point exposed. "With the 
straight bistoiiry and dissecting forceps, the jDarotid border is 
dissected, and under it the aponeurosis of the levator-humeri is 
divided. The finger is then pushed between the aponeurosis and 
the small obhque muscle of the head, in order to reach the occipito- 



460 OPERATIONS ON THE RESPIRATORY APPARATUS. 

hyoideus, whicli is readily identified by feeling for tlie styloid pro- 
cess of the occipital bone and the superior border of the long 
branch of the hyoid. Some little hemorrhage and some strug- 
gling of the patient may follow this incision, caused by the divis- 
ion of the auricular vein and nerve, but the consequences will not 
be serious. 

2d. Puncture of the Poxich through the Muscle. — The central 
point of the muscle being identified, the operator, with a straight 
bistoury held in the manner of a writing-pen, introduces it under 
the parotid, obliquely, from above downward, and from behind 
forward, and thus divides the muscle through and through, and 
penetrates the pouch. If the puncture proves to be sufficiently 
large, the index finger is introduced into the opening for explora- 
tion, and, if necessary, for its fiu-ther dilatation. 

If the collection of pus is not very abvindant, and the mucous 
membrane lining the sac not greatly distended, it will be important 
to have a very sharp-pointed instrument, which will make its work 
of incision sure, instead of merely pushing the membrane away 
from the internal face of the muscle — an accident which might 
lead to serious results. 

But again, when the collection is abundant and the pouches 
much distended, the use of the bistoury may prove unnecessary, 
the puncture being then readily made by pushing the index finger 
through both the muscle and the mucous membrane of the pouch. 

3d. Making a Counter-Opening. — The S probe, or curved tro- 
car (Fig. 398), is introduced through the opening made, and is 
pushed down to the bottom of the pouch, where the mucous mem- 
brane is easily torn ; it is then carefully directed toward a point a 
little below the giosso-facial branch of the jugular, back of the 
thick border of the maxillary bone, and pushing against it with 
sufficient force, the instrument forms a prominent point under 
the skin. If the S probe is used, an incision is made with the 
bistoury through the skin, and the instrument is exposed. If the 
curved trocar, it is by a strong pushing movement passed through 
the skin and brought outside. Whatever instrument may be used, 
a piece of tape or kind of seton is introduced from the lower 
through the upper opening, and the continued escape of pus thus 
facilitated and ensured. The extremities of this piece of tape are 
secured together by tying them with the knot used with the or- 
dinary seton. 



HYOVERTEBROTOMY. 



461 



The attention required by the patients after the operation is of 
the simplest kind, consisting in keeping the wounded surface 
thoroughly clean and keeping up the flow of the pus This will 
at first make its escape through the upper opening, but will soon 
find its way through the lower one, and so long as it is discharg- 
ing the opening must not be allowed to close, nor must the seton 
be moved. 

Puncture in the Middle and the Lower Regions of the 
Parotid. — These modes of operation are so nearly identical that, 
with H. Bouley, we think they may with prox^iiety be jointly con- 
sidered. 

In these cases but little attention to the anatomy of the part 
is requii-ed. The growth of the purulent collection distends the 
pouches, displaces the blood vessels and nerves, separates them 
more or less from the parotid, and becomes more superficial, and, 
in fact, may ulcerate through the skin and empty itself spontane- 
ously. But this process is a very slow, tedious and painful one, 
and subjects the patient to such a degree of suffering, that it be- 
comes a duty imj)erative to interpose the resources of sui'gery for 
its relief. 

The puncture in this case should be made as early as possible, 
and at the fluctuating point, as with an ordinary abscess. It is 
made with the bistoiuy, or, what would be better, with the olivary 
actual cautery, by which the prevention of hemorrhage will be as- 
sured. The opening thus made and cauterized, will, moreover, 
have less tendency to close too rapidly, besides which the modify- 
ing effects of the cauterization will have a highly advantageous in- 
fluence upon the healing jjrocess. 

The opening of the pouch at its lower extremity has been 
recommended when the purulent collection is small, or when con- 
cretions of inspissated pus are supposed to exist in the cavities. 
It is done by first dissecting the wide and thin lower portion of 
the parotido-auricularis, then of the base of the parotid, under 
which the distended pouch is seen and punctured. 

We remember a case where the collection in both cavities was 
such that we had no difficulty in opening them on each side of 
the neck, about on a level with the thyroid glands, the lower 
operation with emphasis ! 

Puncture Through the Eustachian Tubes. — Gunther has in- 
vented a tube, rounded at one extremity, a sort of hollow bougie, 



462 OPEEATIONS ON THE RESPIRATORY APPARATUS. 

which he introduces into the guttural pouches by passing it 
through the 'nasal cavities and the Eustachian tubes. Although 
in performing this operation the animal is thrown down, it is veiy 
difficult to accomplish, and requires to be preceded by the operation 
of tracheotomy. It also requires to be repeated several times, by 
reason of the liability of the collection to return. 

The mode of operation is a matter of no importance, since the 
solutions of continuity resulting from it seldom assumes a form 
more serious than that of an ordinary simple wound, and requir- 
ing no special directions as to treatment. Even ordinary de- 
tergent washes are scarcely necessary. 

LAEYNGOTOMY— AEYTENECTOMY. 

The history of surgical interference at the larynx, to relieve the 
peculiar difficulty of respiration known as roaring, depending 
upon paralysis of the laryngeal muscles, dates as far back as 1845, 
when Professor Gunther, of Hanover, attemj)ted, in succession, the 
resection of the vocal cords, the removal of the vocal cord of the 
paralyzed side of the larynx, the partial excision of the arytenoid 
cartilage, the entire extirpation of that cartilage, the removal of 
the vocal cord and of the corresponding laryngeal vetitricule, and 
finally the fixation of the arytenoid, by an anchylosis at its artic- 
ulation vnth the thyroid cartilage. The results obtained by Gun- 
ther were more or less successful. 

These experiments were repeated by Gerlach, H. Bouley, 
Stockfelth and Bassi, but subsequently repudiated and ignored. 
But in later years Professor MoUer, of Berlin, and George Flem- 
ing, of London, have turned their attention to the subject, with the 
suggestion of various new modes of operating, which have yielded 
results more or less encouraging. The matter has been followed 
up by other veterinarians in various parts of the world, and re- 
cently especially by Professor Cadiot, and the successes which 
have been recorded, though not always perfect, seem to justify the 
prosecution of further inquiries and new trials for the rehef of a 
disease which has thus far baffled the skill of veterinarians, and 
consigned many a valuable animal to the hands of the knacker. 

The operation of Professor Moller, also recommended by Pro- 
fessor Cadiot, as at present practiced, is the excision of the para- 
lyzed cartilage. That of George Fleming is the removal of the 



LARYNGOTOMY ARYTENECTOMY. 



463 



cartilage and the vocal cord. We shall describe the Fleming and 
Cadiot modes as we find them recorded in their own works, 
" Koaring in Horses," by the former, and " The Surgical Treat- 
ment of Chronic Roaring," by the latter. 

The Flemhig Method. — The special instruments necessary 
are small ordinary forceps ; scalpels ; bull-dog forceps ; tracheal 




Fig. 399 —Tracheal Tampon Canula. 



tampon ; a canula, formed of a long tracheotomy tube, with an 
india rubber bag surrounding its middle. This bag is inflated 
by means of an india-rubber air-pump, after the insertion of the 
tube into the trachea, and is useful in preventing the flow of blood 
into the bronchii during the horse's getting up after the operation, 
and for half an hour subsequently. Other instruments required 
are a razor-shaped knife, with which to excise the cartilage ; a bent 
knife with which to remove the muscles from the outside of the 
arytenoid cartilage ; a hook to seize and raise the lower end of 



Fig. 400.— Razor-shaped Knife. 




Fig. 401.— Bent Knife. 



Fig. 402.— Hook to Secure the Cartilage. 



464 OPEEATIONS ON THE KESPIRATOKY APPARATUS. 




Fig. 404.— Curved Scissors. 




Fig. 406.— Electric Lamp. 



the cartilage ; a special forceps with toothed ends, to seize the 
body of the cartilage ; curved scissors to cut through the mucous 
membrane ; two retractors to keep the trachea opened during the 
operation ; and an electric lamp to illuminate the interior of the 
larynx. 

Fleming describes the operation as follows: "The horse 
should be well fed for a day or two preceding the operation, but 
have little or no food or drink for some hours before its actual 
performance. In the case of thoroughbred horses, a dose of four 
ounces of tincture of opium in a pint of water, half an hour be- 
fore operating, is advisable. The hair must be removed closely 
from around the upper part of the trachea and larynx, before the 



LARYNGOTOMY ARYTENECTOMY. 465 

animal is cast, and he is thrown in the usual manner, on a good 
bed of straw or moss or litter. The chloroform bag is put on, and 
when the required state of narcosis is induced, the animal is placed 
on his back, and maintained there by sacks filled with straw, placed 
close under each side of the body. The neck and head are ex 
tended in a line with the body, the head placed on the vertex and 
kept steady by an assistant. The operator places himself in a 
kneeling position, on the off, or right side of the body, if right 
handed, beside the neck, with his back to the shoulder and face 
toward the head." 

The operation is divided into three stages : 

First Stage. — " With a scalpel, an incision of from four to six 
inches in length is made through the skin, the middle Une of the 
larjTix and trachea, opposite the posterior border of the lower jaw, 
extending from the body of the thjToid cartilage to the second or 
third tracheal ring. This exposes the subscapulo-hyoid, sterno- 
hyoid and sterno-thyroid muscles, which are incised to the same 
extent, and as close as possible to their line of junction {raphe) 
in the middle, the section being then carried through to the larynx 
and trachea. There is a variable amount of hemorrhage now to 
contend with, which, if only oozing, may be checked by sponging 
it dry until the blood has ceased to flow ; and if it comes from 
twigs of arteries or veins, they may be seized, and twisted, or 
ligated." 

Second Stage. — "The middle crico-thyroid ligament, cricoid car- 
tilage, and one, two or three tracheal rings are cut through, in a 
straight line, exposing the interior of the larjoix and trachea. If 
blood vessels are cut, they should be taken up. A retractor is 
applied to the sides, and these being pulled gently apart by an 
assistant, there is ample space in which to manipulate. The con- 
vex lower border of the arytenoid on each side can now be seen, 
and if the respiration is deep, that which is next the operator (the 
right), will be observed to move actively from the side toward the 
middle ; jv^hile if the roaring is due to paralysis of the left dilator 
muscle, there is no movement in the opposite cartilage. When the 
breathing is very tranquil, which is often the case, the right carti- 
lage moves almost imperceptibly, and it becomes necessary to as- 
certain whether the left one is really immovable. This can be 
done by passing the finger, or a long probe, up toward the epi- 
glottis, when the act of swallowing will be excited, during which 



4.66 



OPERATIONS ON THE RESPIRATORY APPARATUS. 



the right arytenoid cartilage is energetically jerked into the mid- 
dle of the cavity; but the left one is either motionless or only 
feebly stirs, depending upon the degree of the wasting of the con- 
strictor muscles on that side. 

" If any blood lodges in the trachea, it can be removed by 
large or small (handled) sponges, which may be passed to the 
operator by an assistant who receives and washes them. As the 
horse is now breathing through the wound, the chloroform bag 
may be removed. 

"It is always advisable to examine the interior of the larynx 
carefully, in order to ascertain its exact condition, as there may be 
something more in the case than an immovable cartilage. For this 
purpose the electric lamp is invaluable. 










Fig. 407.— Left Side Section of Larynx, showing the Parts excised in the Operation 

for Roaring. 

" The left arj^enoid cartilage may be excised by commencing 
at the lower convex border, or at the upper part, where it meets 
the right cartilage (Fig. 407). If the latter method is selected, 
then a cut with a razor-shaped knife is made through the mucous 



LARTNGOTOMY AEYTENECTOMT. 467 

membrane, into the arytenoid ligament and arytenoid muscle, as 
close to the margin of the cartilage as possible, beginning between 
the cartilage of Santorini, downward and then upward and the 
vocal process at the insertion of the vocal cord (Fig. 407). The 
hook is inserted in the vocal process, which is raised, and the 
vocal cord is separated from the cartilage by the scissors ; then 
the muscles on the outside of the cartilage are cut with the bent 
knife, or, what is better, pushed from its surface as close as possi- 
ble. The hook is removed, and the body of the cartilage seized 
with the rachet forceps. The mucous membrane connecting the 
cartilage with the vocal pouch is divided, with the curved scissors, 
cutting as close to the cartilage as possible, to save the membrane. 

"The arytenoid cartilage is now free, except at its articula- 
tion with the cricoid, and it may either be disarticulated or cut 
through with the scalpel at this point, care being taken to leave 
no loose portions or shreds. The cartilage being now only retained 
by the soft parts at the upper portion (or base of the arytenoid 
cartilage), these are cut through, close to it, with the scissors, when 
it is altogether detached. 

" Care must be taken to avoid wounding the other cartilages, 
or the pharyngeal mucous membrane, and to spare that membrane 
in proximity to the arytenoid cartilage as much as possible, remov- 
ing only that which covers its surface and the cartilage of 
Santorini. 

" The vocal cord is now removed close to its attachment to the 
thyi'oid cartilage, in front and at its fixed border (Fig. 407). This 
can be done with the scissors, a finger being passed to the bottom 
of the ventricle to facilitate the excision ; or the cord may be 
drawn from the side by inserting a hook iu it, to allow plenty of 
room for the scissors. 

" If the hemorrhage is troublesome, which it seldom is, the 
blood can be mopped out of the trachea with the sponges. It 
cannot pass down that tube, owing to the position of the neck. 
If necessary, the electric lamp may be employed to ascertain how 
the operation has been performed, or even during it performance ; 
but after a little experience this is unnecessary." 

Third Stage. — "The trachea being completely freed from 
blood, and the tampon canula introduced, the bag being inflated 
after it has been properly placed into the trachea by means of the 
air-pump, the canula is secured in position by a tape around the 



468 OPERATIONS ON THE RESPIRATORY APPARATUS. 

neck. It is only required for about half an hour, luitil the hemor- 
rhage has ceased, as it will prevent the entrance of blood into the 
lungs while the horse is getting up, and for a short time after- 
ward respiration being carried on through the tube. It ought 
not to be left any longer, being liable to injure the interior of the 
trachea. The blood being again removed from the larynx, one or 
two syringe-fulls of the common salt or borax solution are inject^ 
ed into it and the pharynx. This washes out these cavities and 
the sinuses of the head, a necessary precaution, as putrefying 
blood in them sometimes gives rise to troublesome consequences. 
Swallowing should be induced by touching the epiglottis, and 
then the horse may be turned on his side, the lower margin of the 
wound being depressed, to allow the remaining blood and water 
to flow out. This completes the operation. 

" The horse is now allowed to recover from the chloroform? 
and when ready he may be assisted to get upon his feet, care 
being taken that the canula is not displaced while doing so. The 
wound is kept open with the finger for a short time, to allow any 
remaining blood to escape, and it is afterward cleansed away from 
around the wound, the face and nostrils sponged to refresh the 
patient, and if the weather is cold, the body clothed and the legs 
bandaged." 

Method of Gadiot. — The special instruments required are a 






Pig. 408.— Blunt Bistoury. 





Fig. 409.— Curved Scissors. Fig. 410.— Spring Tenaculum, or Dilator, 

blunt bistoury, curved scissors, whose blades are nearly perpen- 
dicular to the branches, a spring tenaculum, a hooked or long 
bull-dog forceps, a canula tampon, like that used by Fleming, a 



LAKYNGOTOMY ARYTENECTOMY. 469 




Fig. 411.— Hooked Forceps. 

peculiar curved needle, shown in Figure 418, straight, long and 
ordinary curved scissors, bistouries, dissecting forceps, artery nip- 
pers, loose and fixed sponges, thread, cotton, pheniated or iodo- 
formed gauze, and antiseptic solutions. 

The preparation of the animal is similar to that in Fleming's 
method. 

First Stage. — Incision of the SMn and Muscles covering the 
Larynx. — The incision must be made on the median Hne, and ex- 
tend from the body of the thjToid to the second or third tracheal 
ring. This is done with the convex bistoury, first dividing the 
skin in its whole length, when the edges separating show the 
raphe of the sterno-hyoid and omojDlat-hyoideus muscles. The 
muscular layer can then be divided exactly upon the median line. 
The division of the prelaryngeal connective tissue closes the first 
stage. The hemorrhage is always light and easily controlled. 

Second Stage. — Incision of the Larnyx and of the First Two 
Rings of the Trachea, Introduction and Fixation of the Can- 
ula. — The incision may be made by a single stroke of the knife, 
dividing the crico-thyroid, and with it, successively, the cricoid 
and the crico-tracheal ligaments, and the first rings of the 
trachea. But by this mode of operation, the vocal cords may be 
injured, and to avoid this, the bistoury held perfectly vertical, 
with the edge turned backward, is inserted through the crico-thy- 
roid Hgament, immediately in front of the cricoid cartilage, and 
this is divided with the crico-tracheal ligament, as well as the first 
ring of the trachea. The edges of the laryngo-tracheal incision 
are then opened with the spreaders, or the spring tenaculum, and 
the division of the thyro-cricoid ligament is completed, from be- 
hind forward, and from within outward. As by the act of inspi- 
ration the vocal cords move more or less outward, this movement 
should be carefully watched while making the incision of the 
crico-thyroid membranes to save them from injury. The canula- 
tampon is then introduced, and when in place, is moderately in- 
flated by an assistant, the operator measuring the degree of dila- 



470 



OPEBATIONS ON THE KESPIRATORY APPARATUS. 



tation with his fingers in the superior part of the trachea. When 
it is sufficiently expanded, a ligature is applied upon the India 
rubber tube, and this is cut off. Though the tampon is inflated, 




Fig. 412.— Arytenectomy. The second stej) is over. The crico- thyroid ligament, cri- 
coid cartilage, crico-tracheal ligament and the two first tracheal rings are divided. 
The canula and the tenaculum are in place— <r c, Cricoid Cartilage. 1 B, First Ring of 
the Trachea. 

the canula has a tendency to slip in the larynx, and for the pre- 
vention of this accident should be secured by bands or strings tied 
backward over the neck. 

Third /Stage. — Ablation of the Arytenoid Cartilage. — The 
ablation of the cartilage is effected by several steps : 

(a) Incision of the Mucous Membrane along the Superior 
and Posterior Borders of the Cartilage. — With a blunt bistoury 
and a slight pressure, an incision is made in the mucous mem- 
brane along the side of the superior and posterior borders of the 



LAKYNGOTOMY ARYTENECTOMY. 



471 



arytenoid (see Fig. 413), the instrument being then carried into 
the larynx on the median line, from before backward to the cri- 
coid, and thence from within outward and from below upward, as 
far as the insertion of the vocal cord. To save the mucous mem- 




FlG. 413.— 3d Step, a, Incision of the Mucous Membrane along the Superior and Pos- 
terior Borders of the Arytenoid. 

brane, the incision may be made at some distance from the bor- 
ders of the cartilage, but the division of the membrane must be 
complete. 

(b) /Section of the Vocal Cord / Dissection of the Cartilage 
on its Inferior and Anterior borders and External Face. — With 
long, sharp, straight scissors, the vocal cord is excised at its in- 
sertion upon the arytenoid (see Fig. 414). The cartilage is then, 
by small nips of the scissors, made from behind forward, dis- 
sected in dividing the mucous membrane along its inferior bor- 
der, and the muscular fibres of the crico-arytenoid and thyro-ary- 
tenoid, inserted on its external face (Fig. 415); the mucous mem- 
brane, which covers the anterior border, being divided from above 



472 



OPEBATIONS ON THE RESPIRATORY APPARATUS. 




Fig. 4U.—Sd step, b. Section of the Vocal Cord. 



downward with the scissors. To facilitate this part of the oper- 
ation, the cartilage must be firmly held with either the hooked or 
the bull-dog forceps, and carried toward the median line, when 
the inferior border and the external face are dissected, and drawn 
backward and upward when the dissection goes on, on the ante- 
rior border. The only important or particular caution needed 
here, is to hold the point of the scissors always in contact with 
the cartilage, to keep close to it, to save the mucous membrane, 
and to avoid the laryngeal ventricle as well as the tissues loosened 
from the external face of the cartilage. Toward the end of this 
third step, when the cartilage is separated from the fibres of the 
thyro-arytenoid muscle, a hemorrhage takes place from the divid- 
ed laryngeal branch of the thyroid artery (Fig. 416). This must 
be controlled by torsion or artery nippers. 

(c) Section of the Cartilage near its Articulation with the 



LAKYNGOTOMY ARYTENECTOMY. 



473 




Fig. 4\5.— 3d Step, b. Dissection of the Arytenoid at its Inferior Border and 
its External Face. 



Cricoid. — Raised and immobilized with a strong forceps, or the 
hook forceps, held with the left hand, the arytenoid is separated 
from without inward near its postero-superior angle, the articu- 
lar, with the blvmt bistoury. Held in a vertical direction, or some- 
what obUquely downward and forward, the bistoury is moved to- 
ward the external part of the arytenoid, immediately in front of 
the cricoid, and the section is made by a limited and careful saw- 
ing motion. When the arytenoid is partially ossified, which is a 
condition encountered in nearly one half of the patients, some 
force may be used. A feeling of cessation of resistance, and an 
increased mobility of the cartilage, indicates the completion of the 
section. 

(d) Dissection of the Cartilage by its Superior Face (Fig. 417). 
— This is done with the curved scissors. The cartilage being well 



474 



0PEEATI0N8 ON THE BESPIRATOJBY APPARATUS. 




Fig. 416.— Sd Step, c, Section of the Arytenoid near its Articular Angle. 
A, Laryngeal Branch of the Thyro-Laryngeal Artery. 

raised with the forceps, the scissors are introduced under its poste- 
rior portion, with the branches held almost vertically, and close to 
the cartilage, from behind forward, and the fibres of the arytenoid 
muscle are nipped off. With careful attention, the perfect dissec- 
tion of the entire cartilage, including its beak, may be effected. 
During this part of the operation, blood and pharyngeal mueosi- 
ties may interfere with the manipulations, and must be removed 
with pieces of soft cloth, wadding or sponges. 

When these various manipulations have been well executed as 
described, the surface left by the loss of substance presents a neat 
and smooth appearance, not only on its borders, but over its en- 
tire extent. Professor Cadiot, in this step of the operation, omits 
the excision of the vocal cord, which he considers unnecessary. 

Fourth Stage. Suture. — The borders of the wound are brought 



LARYNGOTOMY ARYTENECTOMY. 



475 




FIG. 417.— Sd Step, d. Excision of the Cartilage with the Curved SciBSora. 

together with two or three interrupted catgut sutures, made with 
a special needle (Fig. 418). Three of these are generally re- 
quired (Fig. 419). 

After cleansing the larynx of the blood, it is dressed with wad- 
ding or iodoformed gauze. The edges of the external wound are 
brought together by two interrupted sutures, one upon the mus- 
cular coat, the other on the skin, the latter being so placed as to 
prevent the displacement of the canula. 

The care of the wound, aside from the matters of cleanliness 
and the apj^lication of antiseptic measures, varies according to the 
two modes of operation. But they agree in advising the early 
removal of the canula at a period not later than the day following 
that of the operation. 

Careful diet is indicated, but Fleming advises strict fasting 
from both food and water for two or three days, while Cadiot per- 
mits the animal to have his ordinary diet without interruption. 



476 



OPERATIONS ON THE RESPIRATORY APPARATUS. 




Fig. i18.—Uth Step. How to Apply the Sutures. 



There is no serious febrile reaction, and after three or four weeks 
the cicatrization is complete. 

The result of the operation cannot be fully ascertained until 
about three months after the operation, when the animal can be 
tested. 

The appHcation of the sutures constitutes an improvement, we 
believe, on Fleming's operations for assisting the cicatrization of 
the laryngeal wound, which, however, can be more easily watched 
if the external sutures recommended by Cadiot are disj)ensed 
with. Excessive granulations, when detected, must be cauterized 
with chloride of zinc or nitrate of silver. 

Among the accidents and complications that may follow ary- 
tenectomy, and which are mentioned by Fleming and Cadiot, are 
wounds of the mucous membrane and of the arytenoid left in the 
larynx, incomplete deglution of the dressing, pneumonia from 



TBACHEOTOMY. 



477 




Gig. 419.— The Sutures are in Place ; three are necessary. 

foreign bodies, excessive granulations of the cicatrix, pyemia, 
tetanus, besides those which result from the division of the carti- 
laginous structure, such as deformity of the tracheal rings, and 
the contraction of the tracheal diameter. 



TBACHEOTOMY. 

This term represents an operation consisting in making a 
methodic opening of varying dimensions, in the cervical position 
of the trachea, in order to provide a free channel for the atmos- 
pheric air into the respiratory tract. Its ultimate object is either the 
removal of foreign bodies, or of the abnormal growth from the 
larynx, or to facilitate the passage of the air necessary to respira- 
tion. Its subjects are principally the large domestic animals, more 
especially the horse, and it has also been employed with advantage 
on ruminants, and often successfully on dogs. 



478 



OPERATIONS ON THE RESPIBATOEY APPARATUS. 



The importance of the operation, with its utility, is readily 
demonstrated by studying the effect of its performance, and esti- 
mating the rehef which immediately follows, in some special cases 
of aihnent or accidents, complicated with the danger of immi- 
nently impending suffocation. It is performed in the middle of 
the inferior border of the neck, in that portion where the trachea 




riG. 520.— Tracheal Region. T, Trachea; A A, Sterno-Hyoideus and Thyroldeus Mub- 
cles; SH, Sub-Scapulo-HyoideuB; S 1/, Sterno-Maxillaris ; cT, Jugular Vein. 

being most subcutaneovis, can be readily felt, in the lozenge 
formed by the diverging branches of the sterno-maxillary muscles 
below, and the two converging sub-scapulo-hyoideus above. The 
trachea is here merely covered by the subcutaneous band of the 
sterno-hyoideus and sterno-thyroideus, and tLe whole is wrapped 



TRACHEOTOMY. 479 

by the thin expansion of the cutaneous colli. In this middle third 
of the neck, the cartilaginous rings of the trachea, with the liga- 
ments between which unite them, are readily identified. 

The indications of tracheotomy, which are quite numerous, 
are enumerated by Zundel, iinder five principal heads : 1st, when 
an obstacle exists which interferes with the free access of air to 
the lung, as in case of contraction or obstruction of any portion of 
the air j)assages, including all the diseases of the upper part of the 
respiratory tract, and acting directly, such as acute laryngitis, 
oedema of the glottis, and polypi or paralysis of the larynx ; or to- 
gether with those which act indii-ectly, as strangles, pui'ulent col- 
lections in the guttural pouches, anasarca and purpura hemon*ha- 
gica ; 2d, when foreign bodies have become lodged in the fauces or 
the larynx, in order to facilitate their extraction, either directly, by 
means of special forceps, or indii'ectly, by pushing them back into 
the mouth to enable the surgeon to grasp them with his hand ; 3d, 
to remove tumors, polypi, cysts or cancerovis growths ; 4th, in cases 
of fractures of the bones of the face, of the cartilages of the larynx, 
or of the trachea ; and 5th, again, when the trachea has become 
the seat of any specific lesions, such as tracheocele ; caries of the 
tracheal cartilages, or of deformities, such as may result from frac- 
tures, ossifications and contractions. 

The operation is, however, contra-indicated when the cause or 
object which impedes respii-ation occupies a point so low in the 
passage as to be beyond reach by the tracheotomy tube ; or when 
the difficulty in breathing and the danger of suffocation are due 
to a diseased condition, either of the lungs or of the heart. 

The instruments required for the operation are : a paii- of 
curved scissors, a convex and a pointed bistoury, a sharp-pointed 
tenaculum, a bull-dog forceps, two blunt tenaculums and a trach 
eotomy tube. Some special instruments for the division and am- 
putation of the trachea have been invented, but the tracheotomes 
as they are called, do not generally serve as good a purpose as the 
ordinary instruments already named. 

Tracheotomy tubes are of various forms and devices. Some 
are of very simple construction, and others are more or less com- 
pHcated. The ordinary tube consists of a bent and curved can- 
ula, made of various diameters, more or less cylindrical, and 
secm-ed on a square j)late, nearly fiat, or with a curve in order 
to adapt it to the convexity of the neck, and with an eyelet or 



480 OPERATIONS ON THE EESPIEATOKY APPAKATUS. 





Fig. 421.— Ordinary Tracheotomy Tube, front and back view. 



slit at each corner, for the attachment of bands or straps. These 
tubes are generally made of silver or nickel-plated metal, though 
gutta percha is the material sometimes used, its lack of solidity, 
however, rendering the instruments composed of it uncertain and 
dangerous. Besides this ordinary tube, there is a long catalogue 
of others, among which we have those invented by Dieterichs, 
Gowing, Spooner, Vachette, Pradat, Brogniez, Leblanc, Renault, 
Peuch, Imlin, Trasbot, and these do not exhaust the list. But 
among all this host of instruments of this class there is probably 
none which fulfils its purpose better than that of Director Degives, 
somewhat modified by Professor Peuch (Fig. 430), which, by its 
simpHcity, and especially from the fact of its being a self-holder, 
has proved itself to be the most convenient of all for general prac- 
tice. When once inserted and adjusted, this tube may be left in 
place without danger of removal or dropping of itself, while the or- 
dinary tube, which requires to be secured by strings tied over the 
neck, can never be as safe as the self-retaining instruments, which 
hold themselves. 

There are two methods of performing the operation, one of which 
may be called the classical, and the other the immediate method. 
In the former, two adjoining tracheal rings are divided, and re- 
moved, in part or totally ; in the latter, a longitudinal incision is 
made through the rings without loss of substance (Fig. 433). In 



TRACHEOTOMY. 



481 




riG. 422.— Tube of Dieterlchs ; 
posterior view. 



Fig. 423.— Qowing's Tracheotomy Tube. 




Fig. 424.— Spooner'8 Tracheotomy Tube. 

either case the animal is, if possible, kept on his feet, with the head 
elevated by a twitch apphed on the lower lip. It may sometimes 
be necessary to place him in stocks ; to hobble his fore legs, or 
perhaps only to raise one of the fore feet. In some instances the 
patient is unable to stand, and, in fact, is already down when the 
surgeon is called, and this is probably one of the only conditions 
when the longitudinal incision is fully justified. 

Classical Method. — This includes three steps, the object of 



482 OPERATIONS ON THE RESPIRATORY APPARATUS. 





Fig. 425.— Vachette's Tube. 



Fig. 426.— Tube of Pradat. 




Fig. 427.— Tube of Brogniez. 



the first being the the exposure of the trachea ; of the second, to 
open it by removing a circular portion of the organ ; and the 
thu'd by the introduction of the tube into the aperture prepared 
for it. 



TKACHEOTOMY. 



483 





Pig. 428.— Tube of Leblane, momnted 



Fig. 429— Tube of Renault. 




Pig. 430.— Tube of Peuch. 



The operator stands facing the animal, sUghtly on the right. 
Grasping the trachea (the hair having been closely cUpped), he 
fixes and stretches the skin with the left thumb and fore finger, at 
about the middle of the tracheal region, and incises it with a sin- 
gle stroke of the convex bistoury, cutting through the skin and 
the cutaneous muscle. The incision is about three inches in 
length, and exposes the stemo-hyoideus and thyroideus muscles. 
These must be carefully isolated from the face of the trachea by 



484 



OPERATIONS ON THE RESPIKATORY APPARATUS. 




Fig. 432— Tube of Trastoot 

6 




Pig. 433.— Trachea, open for the introduction of the Tube. 



TRACHEOTOMY. 485 

tlie dissection of the cellular tissue which confines them, and drawn 
apart by means of two blunt tenaculums, leaving a gaping wound 
through which to reach the trachea, which is thus exposed, and 
in readiness for the second step of the process. 

Second Ste}). — In the second step portions of the two cartilages 
which have been selected, are held by the pointed tenaculum, passed 
through the connecting ligament, are excised, and a circular open- 
ing established by the removal of a semilunar segment from each 
ring. It is necessary at this point to be certain that the isolated 
valve is securely held, to guard against the force of suction, by 
which it may be hable to be drawn into the trachea as the new 
breathing place is suddenly opened. 

Third Stej). — This consists in the insertion of the tube into 
the aperture prepared for it, and is the simplest and easiest part 
of the procediu-e. The only difiicvdty likely to occur is from the 
neglect or error of the operator in measuring the dimensions of 
the opening, and securing a perfect coaptation between that and 
the tube. If the oj)ening proves to be too narrow, it must, of 
course, be enlarged, with the caution before mentioned against 
losing any detached portions by the suction of the trachea. The 
buU-dog forceps is of value here. If the tube is of the self-hold- 
ing kind, its introduction completes the operation ; but if the or- 
dinary tube before described is used, the tjdng over the neck of 
the tapes attached to the flat plate becomes the final manipulation. 
If no tube is at hand, the wound must be held apart with tapes 
applied upon its edges, and tied over the neck. 

Immediate Operation by Longitudinal Incision. — This is 
done with the sharp straight bistoury, passing it at once through 
all the tissues, penetrating the trachea between two cartilages, 
and making a vertical incision of two or three rings. This mode, 
as we have said, is principally justifiable in case of emergency 
when sviffocation is imminent, and no time can be lost in procur- 
ing the instruments necessary for the classical operation. 

There is still another mode of operating, credited to Kris- 
haber, which, from the location where it is performed, is better 
known as sub-cricoidean tracheotomy^ and which consists in mak- 
ing the opening through the crico-tracheal ligament, which unites 
the cricoid cartilage to the first tracheal ring. It includes three 
steps, comprising the incision of the skin and dissection of the 
underlying muscles, the incision of the ligament, and the inser 



486 OPERATIONS ON THE RESPIRATORY APPARATUS. 

tion of the tube. This mode of operating is simple and of easy 
performance, especially in the absence of any swelling of the re- 
gion. It prevents perichondritis, and is not followed by changes 
in the diameter of the trachea. It has, besides, the advantage 
of allowing the tube to be, to a great extent, concealed, and 
thus removes one of the principal objections urged against the 
operation in cases of chronic roaring, for which it might well be 
recommended. 

The subsequent measures vary somewhat, depending upon 
whether the operation has been performed as only a temporary 
expedient, or as a permanent means of relief for the difficulty in 
breathing. In the first case, it is not necessary to remove the 
tube before the acute symptoms, which have required its intro- 
duction, have subsided, which is a condition which generally does 
not continue more than two or three days. If, however, during 
that time the canula of the tube should become closed by the dis- 
charge or other pathological secretions, it must be removed, 
cleansed and replaced, to be left until its use becomes unneces- 
saiy, which will be readily discovered by the restored regularity 
of the respiration when the tube is removed or its canula becomes 
occluded. 

If the tube is to be worn permanently, careful attention should 
be paid to its proper fit and adjustment, and its daily removal 
and thorough cleansing should never be overlooked. It should 
be ascertained that the instrument fits properly, being held with 
sufficient firmness in the opening, and making a safe and moder- 
ate pressure on the soft tissues around. When the instrument 
has been worn for a (variable) time, the opening of the trachea 
has a tendency to contract, and becomes smaller by reason of the 
development of the granulation of the edges of the wound. In 
this case it may become necessary to enlarge the opening, by the 
excision of the granulations, sufficiently to allow of the ready re- 
introduction of the tube. When it becomes desirable to close the 
wound, the removal of the tube, and the application of an ordi- 
nary dressing, protecting it only by a pad of antiseptic oakum, 
kept in place by a few turns of bandage around the neck, is all 
that is necessary. Usually, after two or three weeks the cicatrix 
is complete. 

The operation of tracheotomy may be accompanied or followed 
by various accidents : 



TEACHEOTOMY. 487 

Hemorrhage is rare, the small amount of bleeding whicli 
occurs proceeding from the division of some of the arterioles, 
branches of the carotid, passing between the cartilages over the 
surface of the inter-cartilaginous Hgament. It ceases spontane- 
ously, and never requires any special attention. 

Emphysema of the neck may take place when the cellular tis- 
sue is very loose and the edges of the skin overlap the tracheal in- 
cision. It generally subsides without interference, or by moder- 
ate, regidated pressure. 

Tracheocele. — Renault so denominates certain growths which 
appear on the tracheal mucous membrane, as the result of the ir- 
ritation produced by the friction of the branches of the tube which 
come in contact with it. He claims to have noticed their appear- 
ance six Aveeks after the removal of the instrument. The nature 
of the tumor varies much. They may be purulent, but they are 
more commonly fibrous and of slow growth ; and may sometimes 
take the chai'acter of ossification of the cartilages. If these ob- 
stnictions appear above the seat of the operation, the trouble is 
easily remedied by the reintroduction of the tube, but if, how- 
ever, they are found below that point, it is a more serious com- 
plication, since it requires a second operation at a point below 
that of the first. 

The obstruction of the trachea by plastic exudation above and 
below the seat of the operation, or its contraction, caused by the 
overlapping of the divided ends of the rings which may have been 
incised, may also be met with, and can only, as in the former case, 
be overcome by a second operation. We personally remember a 
case in which the formation of a post-tracheal abscess, which had 
produced extensive contraction in the calibre of the trachea, 
proved fatal through the impossibility of the introduction of a 
tube after a second operation. The patient had been treated sev- 
eral weeks previously for an attack of strangles, which had re- 
quired an operation, and some six weeks after his recovery was 
brought back suffering with a severe attack of roaring. As he 
entered our hospital he fell to the ground, and the second opera- 
tion was rapidly performed by a longitudinal incision, but the 
tubes we had at hand were all too large, and in a few moments 
the animal died. At the post-mortem a large abscess was found 
behind the trachea, just opposite the seat of the first oj)eration, 
and the pus in collecting had so compressed and deformed the 



488 OPERATIONS ON THE BESPIEATORY APPAEATUS. 

trachea that the index finger could scarcely be inserted into the 
passage. 

THOKACENTESIS. 

The usual intention of this operation is the removal from the 
thoracic cavity of suppurative matter {empyema) or blood or se- 
rous fluid, by puncturing the walls of the chest. It is indicated 
in hydrothorax and in some traumatisms of the chest, and when- 
ever there is a large collection of bloody or other fluid in the thorax ; 
in all cases, in fact, where the ordinary forms of treatment have 
failed to relieve the patient thus affected. Although extensively 
performed in human surgery, where the advantages and facilities 
of operating are so many and so manifest, it has naturally proved 
less beneficial to veterinary patients. And stiU, though probably 
in the majority of the cases in which it has been employed the 
relief which has followed it has been of only a temporary charac- 
ter, and served only to prolong briefly the life of the animal sub- 
jected to it, some few cases are on record in which it has given 
very excellent results. The researches of St. Cyr have, moreover, 
demonstrated that the operation is perfectly harmless, contrary to 
the opinion formerly held, and that a large proportion of its fail- 
ures to effect recovery are due to the fact that its apphcation had 
been too long postponed to justify a reasonable expectation of 
success ; when, in fact, it had been deferred imtil the accumula- 
tion of fluid had already become too abundant, and the pleural 
membranes had already assumed the condition of a tendency to 
pyogeny. 

On this point, Peuch and Toussaint remark that if the punc- 
tiire is made when only the lower third of the cavity is full, and 
if after the evacuation of the Hquid a diluted solution of tincture 
of iodine is injected into the pleural sac, as is done in human 
surgery, j)erhaps more satisfactory results might be realized. 
Our own view, however, is that the disposition of the pleura and 
of the cavities, which they form, would scarcely justify the in- 
jection. 

The instruments required are a straight or convex bistoury, 
and a small trocar, straight or shghtly curved. Keul has invented 
^ paraceyito-in^ector trocar (Fig. 434), which is used for both the 
puncture and the subsequent injection of the medical compounds. 
The use of the aspirator (Dieulafoy) is also recommended. 



THOKACENTESIS. 



489 




Fig. 434. — Trocar paracento-injecteur de Eeul. 



According to St. Cyi', the proper 
place for the puncture is between the 
seventh and eighth sternal ribs, a 
little above the spur vein, this point 
permitting the removal of a larger 
quantity of fluid than any other, with 
the advantage also of offering a wider 
space between the ribs, and a dimin- 
ished thickness in the muscular sub- 
stance. Unless there are special rea- 
sons to the contrary, the puncture is 
made on the right side ; if operating 
on the left is indicated, care must 
be taken to avoid injuring the heart. 
For this reason the puncture is made 
between the 
eighth and ninth 
ribs, with the 
point of the in- 
strument turned 
backward. The puncture is made with the patient on his feet, 
and he rarely needs any apparatus of restraiut, though it will 
always be judicious to apply a twitch on his lip. 

St. Cjr describes the operation as follows : " The operator 
makes an incision with the bistoury, about one inch long, near 
the anterior border of the eighth rib or of the ninth, if he is on 
the left side, dividing the skia and superficial muscular layers 
until he reaches the internal intercostal muscle, which he leaves 
intact. In piercing the cavity, he holds the trocar with the right 
hand, guarding agaiast its entering the chest too deeply by keej)- 
ing his fingers sufficiently near the point to gauge and control its 
depth through the remaining undivided muscle. What remains 
then is to withdraw the rod from the trocar, and keep the latter 
in place while the fluid escapes. Any albumino-fibroid clots, 
which may enter the caniila and obstruct the flow of the liquid, 
may be dislodged by introducing a blunt stylet into the tube. 
"When the canula is withdrawn after the escape of a sufficient 
amount of fluid, the wound is closed with a single pin suture. 

The trocar of Mr. Keul is inserted (Figure 434) in the usual 
manner, with the nut E closed, and after removing the desired 



490 OPERATIONS ON THE BESPIRATORY APPARATUS. 

quantity of fluid, the nut F is closed and E is opened. In the 
funnel D, the diluted tincture of iodine is poured and carried into 
the chest as slowly as the operator thinks proper, where it mixes 
with the remaining portion of the fluid. "When the injection re- 
turns in the instrument to a level with the little piece of glass C, 
the nut E is closed, and the instrument removed, thus guarding 
entirely against the introduction of air into the chest. 

In respect to the quantity of fluid that can be safely removed 
at once, there are varying opinions. Some practitioners hold that 
the cavity ought to be entirely emptied, or, at least, so far as the 
location of the puncture allows, while others favor the method of 
discharging the contents by installments. 

According to St. Cyr, who has experimented very extensively 
in this matter, the removal of a small quantity is followed by a 
negative result, the fluid forming again in a very short time ; while, 
on the other hand, if the entire accumulation is taken away at one 
time, amounting, perhaps, to forty or fifty quarts, it must be at 
the hazard of encoimtering, as supervening disorders, syncope, 
rupture of the pulmonary vesicles, congestions, or splenic or hep- 
atic hemorrhages, with an ultimate fatal termination. 

The question thus remains unsolved, and if recoveries have 
been recorded by Lafosse, Jr., Strauss, Massot, Bar and others, 
failures have followed the operation in the hands of Gohier, 
Pilger, Bassi, Dieterichs, Prudhomme, St. Cyr, etc. Pelle and 
Sewell have obtained recoveries when removing all the fluid at 
once. Our own experience has been negative in the cases in which 
we have observed both conditions — that of partial, and, as well, 
that of the entire removal of the fluid. 

Supplementing the operation with medicinal injections of 
some sort has been recommended. Hertwig has used astringent 
solutions ; Leblanc, Bouley and Prudhomme have favored the use 
of tincture of iodine, and the following prescriptions, used in 
human surgery, are recommended by Peuch and Toussaint : 

Weak Solution — 5 — Tinct. of iodine, 10 parts; iodide of 
potass., 1 part ; distilled water, 100 parts. 

This is first used, but, if it fails, the following is injected : 

Strong Solution — 3 — Tinct. of iodine, 30 parts; iodide of 
potass., 4 parts ; distilled water, 100 parts. 

The general treatment recommended for those forms of dis- 
eases in which these liquid accumulations originate, must be per- 



THORACENTESIS. 491 

severed in aftei' the thoracentesis, including the counter-irrita- 
tions, diuretics, tonics, stimulants, alteratives, etc. 

The operation is performed on the dog also in the same man- 
ner as on the horse, but either with smaller trocars, or, what is 
better, with some one of the aspirators recently invented. 

With this animal the results are more satisfactory on account 
of the simplicity and unilateral development of the pleuritic 
effusion. 



CHAPTER X. 

OPERATIONS ON THE CIRCULATORY 
SYSTEM. 

BLEEDING— VENESECTION. 

The term bleeding, or venesection, signifies the opening of 
certain veins for the escape of a portion of the blood, for a ther- 
apeutical, or experimental purpose. If it is designed to reduce 
the volume of the circulation, it is known as general, and is per- 
formed upon some one of the larger blood vessels ; if practiced 
to remove blood only from a given region, it becomes local, and 
in that case the smaller vessels are divided. A better division is 
that which is based on the nature of the vessel which is opened, 
and thus it is phlebotomy, if a vein is opened; arteriotomy, if 
an artery ; and capillary, or arterio-phlehotomy, when the opera- 
tion is practiced upon the capillary system. 

There has been much discussion upon the question of the 
utUity of blood-letting, and strong advocates and earnest oppo- 
nents, who have argued its benefits and denied its usefulness, and, 
in fact, ascribed evil results to its practice, whether the depletion 
affects the general circulation or a limited region. But upon this 
we shaU not enter. Those who maintain its practice consider it 
to be indicated when it is desirable to reduce the activity of the 
circulation, or, on the contrary, to stimulate it in parts where, 
from different causes, it has been temporarily suspended, and to 
stimulate absorption, or to reheve the organism of foreign ele- 
ments. 

It is, however, contra-indicated in all eruptive fevers, in anaemic 
patients, and in those suffering with typhoid diseases. 

The old fashion of " taking blood" as a prophylactic measure, 
or at a certain season of the year, is simply the result of an ignor- 
ant delusion. 

The quantity of blood that can be removed must vary, of 
course, with the size, the nature and the condition of the animal. 



PHLEBOTOMY. 



493 



Gourdon recommends the following scale as representing the aver- 
age bleeding, proper, for the animals named : 

The horse, between 4 and 5 pounds ; large ruminants, 5 to 6 
pounds; pig, 1 to 1^ pounds; sheep, 6 to 9 ounces; dog, 3 to 6 
ounces. 

PHLEBOTOMY. 

Phlebotomy, or the opening of veins, is the mode universally 
adopted for general bleeding, and "is generally performed upon 
superficial veins. 

The instnmients necessary are fleams, lancets, scissors, bleed- 
ing-sticks, pias, pin-holders, graduated jars or vases, and a piece 
of sHk, and, for small animals, bandages. 

The fleam, made in various forms, resembles a small lancet, 
and is secured on a steel support received into a metaUic, horn or 
gutta-percha handle. Ordinarily, two or three lancets of different 




Fig. 435.— Ordinai-y Fleam, with three blades. 

sizes have one common handle, ujjon which they are so mounted 
as to be used singly with facility. 

Some of them, of German make, or of English invention, or 
of a Belgian pattern, act with a spring, like the phlebotome of 
Brogniez;. 

The bleeding -stick is simply a stick of hard and hea%y wood, a 
foot or more in length, with which to drive the fleam into the 
vein. 



494 



OPERATIONS ON THE CIRCULATORY SYSTEM. 




Fig. 440.— Bleeding Stick. 



PHLEBOTOMY. 



495 



The graduated vase is to receive the blood, and at the same 
time measiu-e its flow. In ordinary practice a pail is substituted. 

The pins must be long and strong. The piri-holder is used to 
assist in the introduction of the pin when the suture is made and 
the bleeding terminated. 

Sponges and cold water should be accessible. 

Modus Opeeandi. 

-Position of the Animal. — The standing position is the one 
generally preserved. The animal is held well in hand by an as- 
sistant, and if he aj)pears to be excited and unwilling to stand 
quietly, and soothing treatment has no effect, a twitch is placed 

on his nose, or a cap on his head. 

The operation consists of three steps: 
1st. Preparaiion of the Blood Vessel: 
This consists in api)l}dng sufficient pres- 
sure upon it to temporarily interrupt 
the circulation and cause it to. become 
more prominent under the skin. This 
is done wdth the fingers, and some- 
times with a ligature, when the loca- 
tion of the vessel permits it. In some 
blooded and thin-skinned animals, a 
httle brisk exercise is sufficient to stim- 
ulate the circulation and render the 
veins prominent. 

2d. Opening of the Vessel. — This 
is done with the fleam, the lancet or 
the bistoui-y. The fleam is more com- 
monly used for large animals. Held as 
in figure 441, it is brought opjDOsite the 
vessel, parallel to its course, and per- 
fectly perpendicular to it, and at such 
a distance from the skin as to approx- 
imate very nearly, but without forming 
an actual contact with it. "When in 
this position the fleam is made to pen- 
etrate the vessel by a smart blow with 
the bleeding-stick on the back of the 
blade; some practitioners, instead of 




Fig. 441.— Manner of Holding the 
Fleam. 



496 OPERATIONS ON THE CIECULATORY SYSTEM. 

striking with the stick, apply the blow with their hands, but 
with cattle, the stick is indispensable. The moment the blow 
has been applied properly, the stream of blood escapes freely; 
when the blow has been too light, and the skin only divided, with 
but a scanty or no escape of the blood, it is called a v)hite bleed- 
ing ; and slobbery when the opening is not large enough for the 
escape of a full stream, or when the openings of the vein and of 
the skin are not in apposition, which will be the case if the fleam, 
instead of being held perfectly perpendicular to the skin, has 
been held obhquely. The opening of the blood vessel with the 
spring fleam is performed in the same manner, except that the 
lancet receives its impulse from the spring instead of the stick. 
The puncture with the lancet or bistoury should be made with a 
single stroke of the instrument. In large and superficial veins, 
the spring lancet is as easily and safely managed as the fleam. 

3d. Closing the Blood Vessels mid Stopping the Floto. — 
"When a sufficient quantity of blood has been drawn, and the pres- 
sure upon the vein, which has been continued during the flow, is 
gradually relaxed, the stream ceases, more or less completely. To 
terminate it entirely, a simple stitch of pin suture is appHed. It 
is to be preferred to all other means, such as pressure, bandaging 
or adhesive plasters. The suture is made by grasping the two 
edges of the skin with the thumb and index finger of one hand, 
and slightly raising them, then transfixing them with a long pin 
through their middle, with either the hand or the pin-holder, in- 
cluding a fair amount of skin, and completing it by a special knot, 

made with silk or a loop of the long hair of the 
v?5^j^=!;^ mane or tail of the animal. In applying this 

(l ([ \ M » suture, the skin must not be pulled away from 

the body too far, nor the knot tied excessively 

tight. To keep the wound clean and prevent 
Fig. 448.— Suture after the animal from rubbing off the dressings is all 

that is necessary, for a few hours, after the 
operation. The wound heals by first intention, and the suture and 
the pin can be safely removed after twenty-four hours. 

Phlebotomy in Solipeds.. 

Four of the principal superficial veins are selected for this 
operation in soHpeds ; the jugular, the cephaUc, the subcutaneous 
thoracic and the internal saphena. 



PHLEBOTOMY. 



497 



Phlebotomy at the Jugulae. 

This vein is usually selected on account of its size, its situation, 
and the facility with which it can be opened, and the wound of 
the skin closed. It is, however, contra-indicated when the vessel 
is ia any degree diseased, or when the animal is suffering with 
itching skin diseases. 

Formed by the superficial temporal trunk and the internal 
maxillary vein, the jugular descends through the parotid gland to- 
ward its inferior extremity, receiving several collateral veins, and 
reaches the groove of the lower part of the neck, which from its 
presence is called the jugular groove, until it reaches the lower 
extremity of the neck, when it enters the chest. In its course La 
the groove it accompanies more or less closely the carotid artery, 




Fig. 443.— Anatomy of the Jugular Vein and CEsophagus in the Horse. J J, Jugular 
vein; C, carotid artery; O H, omo-hyoideue muscle; D, oesophagus; S, sterno-maxillaris 
muscle; M, mastoido-humeralis muscle. 



498 OPEEATIONS ON THE CIECULATOKY SYSTEM. 

but in the middle third of its length becomes separated from it by 
the flat ribbon-like structure of the sub-scapulo or omo-hyoideus, 
whose fibres pass obliquely between the two blood vessels, from 
below upward. It is, therefore, in the middle third of the neck 
that the bleeding at the jugular must be made, in order to avoid 
wounding the carotid artery. 

Besides the general rules already stated, this special bleeding 
requires peculiar measures. 

{a) Position of the Animal. — He must be kept well in hand, 
with the head somewhat elevated, and must be prevented from 
seeing the various movements of the operator, by covering his 
head with the cap or mask, or by having the eye, on the side of the 
operator, covered with the hand of an assistant. 

(b) The fleam is generally employed, the size of the blade vary- 
ing according to the thickness of the skin and the condition of the 
blood vessels. The left jugular is generally selected, unless contra- 
indicated for some special reasons. 

(c) Preparation of the Vein. — The application of artificial 
pressure for the dilatation of the vein is not only unnecessary in 
solipeds, but has in some cases proved dangerous. In this step of 
the operation the hand is to be preferred as safer and more reli- 
able than any ligature or bandage can possibly be. 

The compression is made with the fingers of the hand which 
holds the fleam, applying it in the jugular groove, below the point 
where the incision is to be made. The projection of the vein may 
be made more distinct by moistening the hair over the spot to 
be ptmctured, with a wet sponge. The improper habit to which 
some practitioners are addicted, of doing this with their saliva, by 
spitting upon the neck is to be severely condemned. If the bleed- 
ing takes place on the left side, the pressure must be made with 
the left hand, the operator turning his back toward the hind parts 
of the animal. If it takes place on the right side, the pressure is 
made with the fingers of the right hand. 

(d) Opening of the Vein. — Placed as we have described, at 
the side of the neck of the patient, his back turned toward his 
hind parts, and pressing with the fingers of his left hand which 
holds the fleam, as before stated, the operator grasps the bleeding- 
stick, and striking upon the fleam, opens the vein, and the blood 
escapes in a good, full stream. Maintaining the pressure on the 
vein throughout the flowing of the blood, he lays aside the stick 



PHLEBOTOMY. 499 

and tlie fleam, and attends to the flow of the blood into the grad- 
uated jar, or the pail provided to receive it. 

(e) Keeping the Stream. — As we have said, the pressure upon 
the blood vessel must be sustained from the beginning to the end 
of the operation. ReHeving it but for a moment is an error, 
likely to be followed by the introduction of air through the wound 
into the vein. Not only must it be kept up continuously, but it 
must be steady. The habit which largely prevails of mo^dng the 
fingers or the vase up and down along the vein while the pressure 
is applied, and with the idea of stimulating the flow of the blood, is 
most dangerous. If the blood does not escape freely, though the 
operation has been properly performed, an increased circulation 
may be stimtdated by making the animal move his jaws, or shak- 
ing the bit in his mouth, or placing the bleeding-stick or a finger 
of the assistant, into the mouth over the bars, and quietly moving 
them. 

{/) When the bleeding is to be stopped, the operator applies 
one of his fingers over the wound of the skin and gradually re- 
moves the pressure made below it. When this has been done, he 
proceeds to the appUcation of the suture, always introducing the 
pin with the head turned upward, irrespective of the side on which 
the operation has been performed. 

(</) Suhseqxient Care. — This is the same as in other cases, but 
we may add that an animal that has been bled at the jugular is 
unfit to work for thi*ee days, in order to give time for the wound 
to heal completely. 

Phlebotomy at the Cephalic Vein 

The cephalic is one of the terminal branches of the median 
subcutaneous vein, and runs upward and forward to pass toward 
the lower extremity of the coraco-radialis, where it crosses the 
tendinous band which this muscle sends to the anterior extensor 
of the metacarpus, running in the space which separates the sterno- 
humerahs muscle from the levator-humeri, and emptying into the 
jugular, a httle in front of the confluent of those two veins. In 
this course, the most accessible portion is that which rests on the 
inferior extremity of the levator-humeri. The fibrous band of the 
coraco-radiahs is the guide indicating its position, viz., a little in- 
side the forearm, on a level with the anterior and oblique fold 
which separates the arm from the forearm. 



'500 OPERATIONS ON THE CIECULATOKY SYSTEM. 




Fig. 444.— Anatomy of the Cephalic Vein, m, Median subcutaneous vein; b, basilic 
vein; c, cephalic vein; d, inferior extremity of the coraco-radialis; t, aponeurotic band 
extending from the coraco-radialis to the anterior extensor of the metacarpus; s, ster- 
no-humeralis; ft. mastoido-humeralis; «, space between these two muscles; /, humeral 
vein. 

On account of the presence of the other terminal branches of 
the main vein, from which the cephahc rises, viz., the basihc, pres- 
sure upon the cephahc does not allow of its dilatation. To obtain 
this, the animal must be exercised for some time, and when 
brought to stand still, to raise the opposite leg, or to carry the 
leg to be bled forward. 

As the vein is easily displaced from its position, it is hardly 



PHLEBOTOMY. 501 

safe to attempt to open it with the lancet. The fleam is always 
preferable. If the bleeding is from the left vein, the instrument 
is held with the right hand, the operator is placed against the 
shoulder, fleam ha\ing its blade turned downward, the fingers 
resting against the chest, and with a blow of the stick the vein is 
opened.' This bleeding is often accompanied by the formation of 
a hematoma over the course of the vessel, due to the fact that 
very often the fleam has opened the vein through and through. 
This, however, is not a matter of any serious consequence. 

Phlebotomy on the Subcutaneous Thoracic. 

This vein runs on the side of the thorax, on a level with the 
sterno-trochineus muscle, and is readily discovered toward the 
sixth or seventh rib. To render it more conspicuous, a bandage 
can be apphed around the chest, as suggested by Chabert, or by 
carrying the leg of the side to be bled forward, and by rubbing 
hard the tract of the vein, or even by simple pressure with the 
fingers. 

The operation can be performed either by a simple puncture with 
a lancet, or with a fleam, held parallel with the course of the ves- 
sel, and between two ribs, to avoid breaking the instrument against 
one of the bones. The bleeding is stopped in the usual way. It 
is not unfrequently followed by the fonnation of a thrombus, 
which generally disappears by pressure, or astringent local appU- 
cations, and often by spontaneous absorption. 

Phlebotomy at the Internal Saphena. 

The comparatively large size of this vein, and its superficial 
position, both explain and justify the fact that next to the jugular, 
it is the one most commonly selected for the operation. For this 
reason phlebotomy is indicated here, when it is contra-indicated 
upon the vein of the neck. 

The saphena is formed by two branches, and in its course 
crosses slightly the direction of the tibia in running upward on 
the surface of the tibial aponeurosis, arriving at the flat of the 
thigh, formed by the short adductor of the leg, and then dips in 
the space left between this muscle and the long adductor, where 
it empties into the femoral. In this course the vein is superficial, 
covered only by a thin skin, from which it is separated by a thin 
aponeurotic layer. It is at a point where the vein passes over the 



502 



OPERATIONS ON THE CIRCULATOEY SYSTEM. 




Fig. 445.— Anatomy of the Internal Saphena Vein, s, internal saphena vein; e, its 
anterior root; i, its posterior root; /, femoral vein; g, deep inguinal lymphatic glands; 
c, short adductor of the leg; I, long adductor of the leg; a, subcutaneous aponeurotic 
layer; r, fascia lata. 

flat of the thigli that it must be opened. If the operation is per- 
formed with the fleam, the higher the better ; if with the lancet, 
it can be done as the vein passes over the tibia, where it is more 
accessible. 

In operating, the leg opposite the one to be bled is held up 
and backward by a strong assistant, in the posture of the black- 
smith about putting on a shoe. 



PHLEBOTOMY. 



503 



K the lancet is used, the operator, placing himself on that 
side also, bends down, and, looking from under the abdomen of 
the horse, brings the instrument close to the vein, opening it by a 
rapid stroke, and enlarging the orifice by a sHght incising motion 
of the instrument. 

If the fleam is used, the operator assumes the same position, 
and applies it precisely as has been described in the cases ah'eady 
considered. 

Operating on the right side he holds the fleam with the right 
hand and strikes with the bleeding-stick in the left, and vice versa. 

This position of the operator is awkward, and not without 
danger, exposing him to the chances of a blow with the stifle of 
the leg which is held by the assistant. To avoid this, Peuch and 
Toussaint suggest that the assistant, instead of holding the leg 
backward, should carry it forward, and that the operator should 
place himself behind the animal. It is also claimed that in that 
position the vein is more easily exposed. The operation is per- 
formed in the same way, except that the instrument is held with 
the right hand if one opei^ates on the left leg, and with the left 
hand if the bleeding is done on the right leg. 

The flow of the blood in this bleeding is generally slabbery, 
and the introduction of the pin of the suture quite painful, and 
means of restraint are, therefore, often necessary before the ani- 
mal will submit to the application of the sutiire. 

Phlebotomy on Other Superficial Veins. 

Others, besides the veins which have been described, are also 
subject to phlebotomy, but its performance is more with some 
local object in view than that of a general bleeding. 

All are performed with the lancet, the region (Fig. 446) where 
they occur being at the transversal of the face, a ; the angular of 
the eye (b) ; the facial or glossofacial, d ; the superficial nasal, 
(c) ; the posterior auricular (e) ; the deep lingual; the inferior 
caudal, and the median subcutaneous of \\iq forearm. If required 
by their size and position a pinned suture is apphed after the 
bleeding, buf in several instances pressure alone is sufficient. 

Phlebotomy in Large Ruminants. 

The operation is confined to two principal veins of the large 
ruminants. These are the jugular and subcutaneous abdotninal. 



504 OPEKATIONS ON THE CIKCULATORY SYSTEM. 




Pig. 446. 
Phlebotomy on the Jugulae. 

It is performed in the same manner essentially as in the soli- 
peds, and with the same instruments. But as cattle are less sub- 
missive to the preparations which precede the operation, means 
of restraint must be used with them, and they must be tied to a 
tree or a post. The jugular of cattle has thicker walls than 
that of soUpeds, its diameter is much greater, and it is separated 
from the carotid in its whole length by a thicker layer of muscle. 
For these reasons a larger fleam becomes necessary. To dilate 
the vein a strong ligature is applied tightly on the neck, the pres- 
sure of the fingers never being sufficient to furnish the necessary 
force. To open the vein the blow of the stick must be heavier, 
and when properly given is followed, as in soHpeds, by a strong 
stream of blood, which rapidly ceases when the ligature is loosened 
or removed. It is not always necessary to apply a pinned suture, 
but it is always safer and more prudent to do so, though the in- 
troduction of the pin is rendered difficult by the toughness and 
thickness of the skin. The value of the pin-holder is demon- 
strated in this case. 

The thrombus which so often follows this operation is not 
serious, and, in fact, its formation is stimvQated by some practi- 
tioners. 

Phlebotomy at the Subcutaneous Abdominal. 

This vein is of enormous volume, extending from the udder to 
the xyphoid cartilage of the sternum, at the side of the abdomen, 



PHLEBOTOMY. 505 

to terminate in the internal thoracic vein. It is, therefore, easily 
recognized, and particularly so in milch cows, and it is, therefore, 
unnecessary to use the Ugature or any other means to swell its 
dimensions, the pressure of the fingers being more than sufficient. 
A fleam of medium dimension is preferable to the lancet in this 
case. The animal is firmly held by the head, and to prevent his 
kicking, is pulled forward by its tail passed between its hind legs. 
In opening the vein the operator places himself forward of the 
shoulder, his back tvimed toward the head of the animal, holding 
the fleam with the hand corresponding to the side of the animal 
against which he is placed. The bleeding is stopped with a pin, 
or, what is better, a bandage, to prevent the formation of a 
thrombus. 

Phlebotomy on Small Animals. 

Bleeding is seldom performed on sheep. When it is indicated 
it is performed on the facial, the Jugular, the ce2yhaliG, or the ex- 
ternal saphena. The vessel is opened with the lancet, the wool, 




Fig. 447.— Position of the Facial Vein in Sheep. 



if necessary, having been chpped oif from the place of puncture, 
and the wound is closed with a pin suture. 

In swine two sets of veins are ehgible for the operation, the 
posterior auricular, as it runs at the internal face of the ears, 
and the external saphena, where it j)asses along the tendo AchiUes. 
The lancet is used upon both. The first stops bleeding without 
help ; the second is closed with the pin suture. 

In dogs, the jugular is sometimes opened. This vein, from its 
position, requires the application of a string around the neck to 
swell the vessel. The pimcture is made with a small fleam or a 
lancet, and the wound closed with a pin. The external sapherm 



506 OPEBATIONS ON THE CIKCULATOKY SYSTEM. 

being quite large is chosen in preference to the internal, which is 
very small. The place of selection is the superior part of the 
vein, when it nearly reaches the posterior border of the leg. A 
bandage is ajDplied to stop the hemorrhage. The cephalic might 
be opened as it passes toward the interior third of the humerus, 
the wound being closed by a stitch of twisted suture. 

ACCIDENTS OF BLOOD-LETTING. 

The operation of blood-letting may be followed by several 
complications, some being of little importance, while others may 
be suilficiently serious to compromise the life of the patient. 
Among them may be named: The white and the slabbery bleed- 
ing ; wounds of surrounding non- vascular organs ; the thrombus ; 
inflammation of the vein, or phlebitis ; wound of the carotid, and 
the introduction of air into the veins. Others, such as the lesions 
of nerves, syncope, etc., are seldom, if ever, encountered in veter- 
inary practice. 

1st — White and Slabbeky Bleeding. 

It is a question whether these, properly speaking, should be 
classed among the true sequelse of blood-letting. "VVe already 
alluded to them when describing the various methods of perform- 
ing phlebotomy. They are often the result of the disposition of 
the parts, the vein being deficient in size, or more deeply situated 
than natural, and thus imbedded in the loose surrounding cellular 
tissue ; or, perhaps, the cause is an unguarded movement of the 
animal ; and it is often known to be the imperfect manipulation 
of the surgeon in striking the fleam too lightly, or not vertically, 
and so failing to bring the openings of the skin and the vein into 
exact coaptation. 

These accidents are, however, of an unimportant character, 
and are easily obviated by exercising more care and deliberation, 

2d — Wounds of Surrounding Non- vascular Organs. 

(a) Wounds of the Trachea. — The improper action of the 
surgeon is generally chargeable with this accident. He may have 
erred in using too large an instrument, or the error may have con- 
sisted in making excessive pressiu'e when ligating the neck with 
the cord used to effect the distension of the jugular. It is a rare 



ACCIDENTS OF BLOOD-LETTING. 507 

accident, but may be easily recognized by the flow of blood which 
escapes through the nostrils, and possibly by the changes which 
may affect the respiration by threatenings of strangHng, suffoca- 
tion, etc. In this serious case the Hgation of the blood vessel is 
the only means of stopping the hemorrhage. 

(b) Wounds of the Caudal Muscles. — This is comparatively a 
common accident with cattle, but is seldom attended with symp- 
toms of a serious character. The principal danger consists in the 
possibility of the formation of fistulous tracts, more or less re- 
beUious to treatment, as besides the muscles, the tendons, and 
even the bones may have been injured by the iastrument. 

3d — Thkombus. 

This is understood to be a bloody tumor, or hematoma, which is 
formed around the openiag of the vera by the accumulation of the 
blood in the surroimding cellular tissue. It appears when the 
opening of the vein does not accurately correspond with that of 
the skin, or when the iacision of the tegument is too small to allow 
a free flow of the blood through it. It often appears when the 
animal is allowed to rub himself after the operation, or when the 
opening of the vein has iavolved a section of one of the valves. 
Some veins, as the sapheua, the cubital, and the subcutaneous 
thoracic, are more exposed to thrombus than others, even when 
the operation has been well performed and completed. At these 
veins, they are generally not serious, and are readily subdued by 
simple treatment, if they do not spontaneously disapj^ear. 

But the thrombus, which is sometimes encountered at the jug- 
ular, is of a more seiious character, and is not unfrequently com- 
pUcated with phlebitis. 

The symptoms of this lesion are essentially local, and the 
symptoms and the disease are, ia effect, one, consisting of a tumor 
of uncertain dimensions, according to the quantity of blood col- 
lected under the skin. In the beginning it is round, well circum- 
scribed, soft, and slightly elastic to the touch, but the swelling 
soon becomes hard, pei'haps cedematous, or somewhat diffused, 
when it has been caused by rubbing on the part of the animal. 

The simplest cases gradually disappear after two or three days. 
But at other times they are not so tractable, and serious trouble 
may ensue, the tumor becoming stationary, or perhaps increas- 
ing in size, and then changing its character. It becomes warm 



508 OPEBATIONS ON THE CIRCULATORY SYSTEM, 

and pamiiil, assumes aspects of a phlegmonous nature, and per- 
haps becomes complicated with hemorrhages. It is not yet too 
late to look for resolution, but if it does not soon take place, and 
if the symptoms increase, and the swelhng extends, the vein is 
changed into a hard, large cord, and a case of phlebitis is estab- 
lished. 

Absorption and resolution are now the two most favorable ter- 
minations of thrombus, but they are of unusual occurrence, except 
when the tumor is of small size, and promptly attended to. 

Suppuration is the more common event, and if this continues 
to be superficial, recovery may be looked for without obliteration 
of the vein. 

Phlebitis, which commonly accompanies a deep suppurative 
thrombus, is always a serious termination. Abscess of the throm- 
bus, however, may assume various modifications, and may pass to 
a chronic condition, or that of induration, or one of stiU. more 
serious nature, that of gangrene. 

When it has become developed, the animal must be immedi- 
ately secured to prevent him from rubbing the parts, and as early 
as possible the treatment should be directed to the limitation of 
its development and the promotion of its absorption. Local ap- 
pHcations of cold water; astringent compresses, moistened with 
vinegar or lead solutions ; poultices of clay, of soot, or of chalk, 
mixed with vinegar, will very often be sufficient to control or re- 
move the growth. Sometimes, however, the absorption will be 
more effectually stimulated by frictions with cantharidis oint- 
ment, and in a week or ten days the thrombus will have entirely 
disappeared. The Girard ointment, of Venice turpentine and 
bichloride of mercury, is sometimes also very effective. 

If the tumor assumes the nature of an abcess, and this re- 
mains superficial, it may be opened with the bistoury, or the actual 
cautery, and should hemorrhages occur they must be principally 
controlled by pressure. 

4th — Phlebitis. 

The first effect of the inflammation of veins is the coagulation 
of the blood and the formation of a clot in a given length of the 
vascular canal, adherent more or less to the walls of the vessel, the 
result being the partial or perhaps complete obliteration of the 
vein, and hence a certain disarrangement of the circulation, which 



ACCIDENTS OF BLOOD-LETTING. 509 

may be supplemented by the anastomotic action of collateral ves- 
sels above and below the occluded portion. Or, again, the circula- 
tion may be entirely obstructed, and, as a consequence of the in- 
flammatory changes, adhesions follow, between the clot and the 
venous wall, the clot being resorbed, and the obhterated vein 
transformed into a fibrous cord. So long as the inflammation is 
limited to the internal wall of the vessel, phlebitis is known as 
adhesive ; but if it extends to the external or even to the middle 
structure, and becomes suppurative^ it is so distinguished. Either 
of these forms of the disease may be changed by a third modifica- 
tion to that of hemorrhagic phlebitis. These three forms or diver- 
sities of the disease have been established by Peuch and Tous- 
saint, whose views touching the treatment of the alfection we also 
reproduce, referring our readers for the pathological history of 
the lesion to the various works relating to it. 

1st. Adhesive Phlebitis. — At the beginning of the disease, the 
animal must be placed under such conditions as will tend most 
favorably to influence the process of organization between the 
clot and the venous waUs, and to prevent the estabUshment of 
suppuration. To effect this object, the enforcement of a state of 
immobility in the patient is most essential. His head must be 
firmly secured on both sides, and his mastication made as easy as 
possible, by suitably regulating the consistency of his diet, in 
order to diminish the force of the circulation, and so far ob%date 
the danger of the displacement of the clot and possible resulting 
hemorrhage. The diseased parts should be treated by local ap- 
phcations, among which lotions of lead water, with continued cold 
water irrigations, will give excellent results. But ointments of 
any kind should be avoided, especially in warm weather, from their 
liabihty to become rancid and irritant, and to stimulate the patient 
to rub himself. The use of cooling applications must be perse- 
vered in, in preference to the frictions with vesicatories, which, 
especially in nervous animals with tender skin, might be liable to 
encoiu'age the suppurative process. In tougher-skinned animals, 
and those of a lymphatic temperament, in which the inflammation 
has a tendency to become chronic, resolvents, blistering, liquid 
liniments, and alteratives are indicated, and of these, and first in 
order, must be named cauterization with the red iron. The 
conical cautery is apjjlied on closed, fine points, and arranged 
quintuply, every second point being deep, while the others are 



510 OPERATIONS ON THE CIKCULATORY SYSTEM. 

only superficial. By tliis peculiar mode of firing the absorption 
becomes greatly stimulated, and the resorption of the tumor very 
rapid. Cauterization, however, if beneficial in chronic, is not so in 
acute cases, having in the latter a tendency to be followed by sup- 
puration, 

2d. Siippuratme Phlebitis. — For this form of this serious af- 
fection several modes of treatment are proposed. 

{a) Expectant Treatment. — This is the plan by which the phy- 
sician or surgeon, administering palliatives only, trusts to the vis 
conservatrix for cure, watching meanwhile the development of the 
disease, and waiting for and expecting the guidance of nature in 
respect to his own interference. 

{b) Simple Incisiooi. — This is the simplest of surgical inter- 
ferences, and means nothing more than the opening of the abscess, 
the enlargement of the fistulous tract, and the formation of an 
exit for the pus and coagulated blood which it contains. This is 
done with an ordinary bistoury, guided by a probe or grooved 
director. 

(c) Injections. — The fistulous tract which exists on the phle- 
bitic tumor is washed with a detersive injection of solutions of 
tincture of iodine, or perchloride of iron ; or of corrosive subli- 
mate, from T^ff to TFinr. These are intended not only to remove 
any remaining clots softened by the suppuration, but also to 
stimulate the granulations and the cicatrization. 

id) Enlargem,ent of the Fistxda and Introduction of a Seton. 
— An S probe is introduced into the fistula, and when it has 
reached the upjDcr part of the swelling formed by the vein, close 
to the obturating clot (which must not be disturbed), an incision 
is made over its blunt end to enable it to pass out through the 
skin. The fistulous tract is then enlarged with the straight bis- 
toury from below upward to a small extent, and between the two 
openings a small seton is passed by means of the probe, and se- 
cured in place by knotting the ends. The movement of the seton 
by drawing it to and fro, effects the removal of such portions of 
the clot as may remain in the wound. 

(e) JEnlargement of the Intra Venous Fistula in its Whole 
Length. — This consists in opening the tract from its commence- 
ment to its superior cul de sac, as far as the adhesion between 
the clot and the vein extends, the incision sometimes reaching 
below the opening made by the fleam. Thus exposed, the tract 



ACCIDENTS Oi' BLOOD-LETTING. 511 

is washed out with the tincture of iodine or perchloride of iron 
solution, or even destroyed with the actual cautery. The last two 
forms of treatment, however, are dangerous, from theii' liability 
to occasion consecutive hemorrhages. 

3d He^norrhagic Phlebitis. — The most serious incident of 
phlebitis, proceeding, as it does, from both the adhesive and the 
supj)urative forms, is the more or less abundant hemorrhage, 
which, resulting from any of the various causes which have been 
mentioned, may interfere with the cicatrization or obliteration of 
the venous wound. Three modes of treatment are practiced for 
their suppression. These are the twisted and the quilled suture, 
and the ligation of the vein. 

(a) The Twisted Suture. — This consists in the combitiation of 
several (two or three) long pin sutures, placed upon the wound 
made by the fleam, and including a larger portion of the skin at 
the sides than the single pin suture of an ordinary bleeding. 
Sometimes wooden pins are substituted for those formed of me- 
talUc material, and when the sutures are completed, the wound is 
strengthened by a coating of some strong, adhesive mixture. 
Some practitioners, however, prefer to this the application of a 
severe blistering friction, which, by the pressure of the swelling 
which it produces upon the internal circumjacent parts, secures 
practically all the effects to be obtained by a compressive bandage. 

(b) Quilled Sutures. — These are applied on each side of the 
wovind, securing a good hold by placing them at some distance 
from the edges, and embracing tightly between them a thick por- 
tion of the skin. This point is important, for the reason that this 
portion of skin is destined to be sacrificed by being left to slough 
off, and this must not take place until the obhteration of the woiuid 
is entirely completed. 

(c) Ligature of the Vein. — The success of this operation, to be 
assured, requires the selection of a healthy portion of the vein on 
which to place the ligature, even if it become necessary to look 
for it among the original roots of the jugular, viz., the facial and the 
glosso-facial. In performing it, the animal must be secured in the 
recumbent position. A single incision is made through the skin, 
the whole extent of the obliterated vein, parallel to its axis, and 
the vessel exposed and separated from the surrounding tissues. 
The separation, which requires skillful and cautious manipulations, 
can be effected by means of either a director or a long probe. It 



512 OPERATIONS ON THE CIECULATOBY SYSTEM. 

will be no more than a wise precaution to apply a second ligature 
below the clot, to prevent the possibility of the escape of suppura- 
tive matter into the general circulation. The material of the 
ligature may be either ordinary linen cord or silk. Our own pref- 
erence is for sterilized catgut. The resulting wound is treated in 
the manner proper for all similar wounds, and in from twenty to 
twenty-five days complete recovery may generally be looked for 

4th. Wound of the Carotid. — This complication of phlebotomy 
at the jugular is not of common occurrence, but is easily possible. 
It may become one of the consequences of using a fleam unneces- 
sarily large, and out of proportion with the dimensions of the vein 
and the thickness of this skin ; or it may be caused by the exhibi- 
tion of needless violence, in striking too heavy a blow with the 
bleeding- stick. Nor are these the only causes to which wounds of 
the carotid may be referred. An abnormal anatomical disposition 
of the arterj, either permanent or temporary, may cause it to re- 
ceive the wound designed for its neighbor the jugular. 

The symptoms pertaining to this accident are very character- 
istic. The color and volume of the blood, and the rapidity of the 
per saltum flow of the stream are sufficient evidences of the 
arterial and non-venous source of the hemorrhage. Concurrently 
with this, a swelling takes place around the edges of the wound, 
increasing with greater or less rapidity, and nearly resembling the 
ordinary thrombus of venous extravasation, though difl'ering from 
it by the rapidity of its formation. 

This false aneurism is now subcutaneous, and has a tendency 
to extend itself downward toward the lower part of the neck, and 
has, indeed, been found extending as far as the entrance to the 
chest. 

This accident is generally one of a serious nature, not alone 
in itself, but often because of the specific manipulations which it 
necessitates in order to overcome it. There are, however, several 
fatal cases on record. The indications of treatment may be either 
quite simple, or, at times, of serious import. If the puncture of 
the artery is but a small one, and the flow not abundant, one or 
two strong pin sutures may be sufficient to control it, especially if 
associated with it steady and firm pressure is estabhshed directly 
upon the course of the vessel, either by compressive bandages, or, 
what is better, with the fingers firmly pressing in the jugular 
groove. If, however, the wound is large, and accompanied by a 



ACCIDENTS OF BLOOD-LETTING. 513 

correspondingly profuse hemorrhage, it becomes necessary to have 
recoiu'se to the direct applications of a ligature. A description 
of this operation will be made the subject of our chapter on 
hemostasia. 

5th. Introduction of Air into the Veins. — This is one of the 
most remarkable of the accidents attending the operation of phle- 
botomy. The phenomenon has been observed as early as the seven- 
teenth century, but it was not until 1806 that it was observed and 
recorded as belonging to the category of casualties connected with 
the famiUar act of blood-letting in an animal. The first author to 
put the occurrence on record in this connection was Verrier, who 
reported a case in 1806, and he was soon followed by others with 
accounts of theii* experience with the same lesion and operation in 
human practice. 

There are two principal causes to which this accident can be 
attributed. One of these may be an unnecessarily large aperture 
in the vein, but more commonly it follows improper manipulations 
on the pai't of the surgeon, particularly the irregular pressure 
made upon the vein during the flow, by many practitioners, who 
have formed the habit of rubbing the vessel along its length, 
under the erroneous idea that by this movement they accelerate 
the bleeding. Again, and perhaps principally, the casualty may 
be the result of neglecting to close the wound of the skin with 
the finger below the point from which the current proceeds, before 
the pressure upon the vessel is stopped. 

The occm-rence is made known by a peculiar gurgling sound, 
which is made more evident by auscultation of the heart. In the 
meantime, the animal is attacked by shiverings; the respiration 
becomes accelerated ; there is a rapid heaving of the flanks ; the 
body becomes covered with perspiration ; the action of the heart 
is quickened; the countenance becomes anxious; the animal is 
seized with convulsions ; falls down and dies, imless by the con- 
tinuance of the flow through the open vein the air may be carried 
out through the same channel by which it entered, or unless the 
quantity has been very minute. As the result of our own study, 
tested by many experiments, we have become strongly incUned to 
beheve that the quantity of au' necessary to produce death must 
be very large, more, in fact, than a careful operator would allow 
to enter without attempting to prevent it. 

The possibility of the occurrence of this accident may easily 



514 OPERATIONS ON THE CIRCULATOKY SYSTEM. 

be obviated, seeing that it merely requires careful attention to 
tbe execution of the few details which constitute the act of vene- 
section. But when it has taken place, the simplest and most ob- 
vious thing to do is, if possible, to remove the air from the vessel 
in which it has intruded. The means of effecting this consists in 
reopening the closed vein, and permitting the blood to resume 
its flow. The loss of three or four pounds of blood additional 
is usually sufficient to insure the escape of all the air. Gourdon 
recommends, in addition, showering with cold water, stimulating 
frictions, and even, if the case seems to require it, artificial 
respiration. 

AKTERIOTOMY. 

Bleeding from an artery is so termed to distinguish it from 
phlebotomy. It is not commonly used in practice, being princi- 
pally resorted to as a means of local depletion, and is performed 
only on some of the most superficial of the vessels. In fact, there 
are but three of these eligible by their position to the operation. 
These are the transveral of the face, the ^^osterior auricular, and 
the middle caudal. 

The modus operandi differs but little from that of phlebot- 
omy, except that there is usually no need of the appHcation of ar- 
tificial means to swell their bulk or increase their rotundity, their 
position, and their distinct and characteristic pulsation, so readily 
detected, sufficiently revealing their location and course. In open- 
ing arteries the fleam is seldom used, the lancet or a pointed bis- 
toury being a much more eligible instrument. The incision of the 
vessel is made across its course instead of longitudinally, as in 
phlebotomy, and the flow of blood must be arrested by means of 
pressure with compresses or bandages. 

(a) Bleeding at the Transversal of the Face. — Though the 
position of this artery is nearly correspondent in all animals, it is 
principally with solipeds that it is chosen for blood-letting. It is 
situated below the temporo-maxiUary articulation, and crossing 
the direction of the fibres of the masseter muscle, where it is cov- 
ered only by a fine skin, it is opened at the same level with the 
place where phlebotomy is usually performed. Some operators 
prefer casting the animal, others the standing position. 

The appearance of the vessel is that of a small, round pulsa- 
ting cord, and, as before stated, it is incised, not as the veins and 



AETEEIOTOMY. 



515 



opened, but in the direction of its axis. The stream differs from 
that which flows from a vein, and instead of issuing with a regu- 
lar flow, escapes per saltum, or by alternating leaps, synchronous 
with the action of the heart. It also differs from that of the veins 
in color, being of a lighter and brighter red. As the appHcation 
of a pin sutiu'e will scarcely be sufiicient to perfectly suppress the 
flow, pressure must be resorted to, either by direct application 
over the posterior border of the maxillary bone, or over the place 
where the artery passes, or by covering the incision with a pad of 
oakum, retained by means of a circular bandage passing by sev- 
eral turns over the upper part of the head. The animal should 
be tied up for several days after the bleeding, or until the closing 
of the artery is fuUy assured. 

{b) Bleeding at the Posterior Auricular. — Though the trans- 
versal of the face can be opened in large ruminants, as well as in 
horses, arteriotomy in those animals is more commonly performed 
upon the posterior auricular, where it is attended by all the con- 
ditions of size and position required to serve the convenience of 
the surgeon. In cattle, upon which it has been practiced for both 
its general and local effects, it has been recommended in diseases 
of the brain, and for affections of the eyes and other parts of the 
head. The posterior auricular runs under the parotid gland from 
the base of the concha upward on its external face, near its supe- 




Pig. 448.— Anatomy of the Posterior Auricular Artery in Cattle. 



516 OPERATIONS ON THE CIECULATOEY SYSTEM. 

rior border, where it loses itself. It is most superficial toward 
the base of the cartilage as it issues from under the posterior cer- 
vico-auricvilar muscle. 

The operation is comparatively simple. The animal being firmly 
held or tied to a post or a tree, hard friction is applied to the 
ear to stimulate the circulation and render the artery more promi- 
nent. The concha is held by the left hand, with the index finger 
in front and the thumb behind the artery, the incision is made 
by piercing the vessel with the lancet held perpendicularly to the 
concha, the artery being cut directly across, and the iacision en- 
larged by a downward movement of the instrument. This is fol- 
lowed by the appearance of a few drops of arterial blood, but 
which soon stops unless the flow is assisted, which is done by the 
operator, without releasing the ear, by striking Hght blows or taps 
with a smaU stick along the course of the artery between the in- 
cision and the auimal's head. This last step is indispensable to 
obtain a good, free flow, per saltum, of course. This whipping 
process is continued until the stream becomes abundant, but may 
be suspended when it reaches that point, to be renewed again, 
however, if the hemorrhage diminishes. Artificial means to close 
the incision are not usually required, the flow generally ceasing 
spontaneously, but when that fails to occur a pin suture or a 
bandage at the base of the concha, or finally the ligation of the 
artery, if necessary, wiU effect the object. The animal must be 
kept confined for some time, to prevent him from rubbing the 
wound or shaking his head too violently. 

In sioine, this artery is so easily reached that it is often se- 
lected in preference to other blood vessels which may be more or 
less imbedded in the fat of the animal. The knowledge of its 
j)osition is very important, as it is very small and difficult to find. 
Running vertically between the temporo-maxillary joint, it reaches 
the base of the concha, and passes by the side of its convex sur- 
face towards its point. It must be opened at the lower third of 
the cartilage, where it presents its largest dimensions. The artery 
must be cut transversely with the lancet. The bleeding ceases 
spontaneously, or, if necessary, may be treated in the manner in- 
dicated for cattle. (Fig. 449.) 

(c) Bleeding at the Median Caudal. — In cattle this artery is 
quite large and very superficial. It runs along the inferior face of 
the tail, being covered at the base of that organ by the inferior 



CAPILLAEY BLEEDING. 



517 




Fig. 449.— Anatomy of the Posterior Auricular Artery in Swine. 

caudal muscles, then becoming superficial and readily accessible 
to the end of the member. In opening it, it is pierced by the 
lancet in the longitudinal axis of the vessel, the tail being kept 
elevated. Ordinarily, however, not only is the artery cut directly 
across, but the skin or surrounding muscular fibres are included. 
The incision must be made on a level with the superior third of 
the tail ; higher up the operation may be complicated with abscess, 
disease of the vertebrae, sloughing of the tail, etc. If it becomes 
necessary to stimulate the flow of blood the same "whipping" 
process may be employed that was recommended in bleeding from 
the posterior auricular. A bandage may be applied round the tail 
to stop the hemorrhage, though it is not commonly needed. 
A few practitioners prefer to operate with the fleam. 



CAPILLAEY BLEEDING. 

The consideration of the operation which consists in the de- 
pletion of the minute extreme vessels naturally and logically fol- 
lows that which treats of a kindred procedure with the veins and 
arteries. The intention of the treatment instituted for all is the 
same, and their curative efl'ects are adapted to similar ailments. 
These are principally local, and may be divided into two classes, 
to wit : those which have been in a great measure discarded from 
general practice, and those which still retain their place in the 
domain of veterinary surgery. The former includes bleeding at 
the palate, the coronet, and the foot, and the latter comprehends 



518 OPERATIONS ON THE CIRCULATORY SYSTEM. 

the punctures, the scarifications, the ventouses, or cupping, and 
the leeching, of regular current practice. 

(a) Punctures and Scarifications. — These are methods of 
producing small superficial wounds through the skin and the sub- 
cutaneous cellular tissue, to obtain the effect of a local bleeding, 
or the escape of any other fluid contained in the subcutaneous 
substance. They are indicated against local swelHngs and serious 
effusions, or oedema of the cellular tissue. They can be applied 
upon any part of the body, and though they take effect in the 
escape of but small quantities of fluid, their action may be stimu- 
lated by additional local appHcations, such as warm poultices, 
warm water fomentations, or dry, stimulating frictions. 

Punctures, however, are principally effective when employed 
to overcome cedematous swellings of the extremities, and of the 
genital organs, while scarifications are prescribed with better ad- 
vantage to obtain the resolution of cold or chronic swellings, or 
to control the Inflammatory process in cases in which the tissues 
are largely swollen and threatened with gangrene. 

Both the bistoury and the lancet, and, in rare instances, the 
fleam, are used in fulfilling these indications. 

In making punctures the skin and cellular tissue are pricked 
or pierced to the depth required, with the bistoury or lancet, by 
rapid thrusts distributed over the entire surface of the swelling, 
and when the fleam is used it is manipulated precisely as when 
used in bleeding, though, of course, with quick repetitions. 

(p) Scarifications may be defined as rather small incisions, made 
with a convex bistoury, with which the skin is cut from without 
inward, iu parallel series, but which, in some instances, when an 
increased effect is desired, are doubled by a second series crossing 
the first at an angle. 

(c) Cupping. — This mode of obtaining capillary bleeding is 
very seldom employed in veterinary practice. The cups are, how- 
ever, indicated in subcutaneous inflammations, accompanied with 
swellings, and resulting from blows, contusions, kicks, and other 
and similar traumatic causes, and are often preferable to blisters. 
They are recommended in arthritis, ostitis, and even in internal 
phlegmasia. They render valuable aid in emptying some forms 
of abscesses, and are credited with the possession of power to 
aiTest or prevent the absorption of virus introduced into wounds 
or deposited on their surface. 



CAPILLARY BLEEDING. 519 

There are two modes of cupping, the dry and the scarified, or 
wet. The dry cup consists in the simple apphcation of the in- 
strument upon the skin to produce a swelling, accompanied with 
more or less injection of the capillary vessels, and a local irrita- 
tion, which generally rapidly subsides. 

The operation of scarified cupping consists, first, in applying 
the instrument to produce the swelling, and when the tumefac- 
tion is sufficient following it with the scarificator. In completing 
the first step, which is the same as for the dry cuppings, several 
means are used. The skin being prepared by clijDping or shaving 
off the hair, a small glass globe, filled with heated air, is placed 
over the spot selected for the operation. A small ball of wadding 
or oakum, either dry or moistened with an inflammable liquid, is 
placed in the glass and lighted, and as it begins to burn the glass 
is pressed upon the skin. To avoid burning the skin, inmiping, 
or vacuum-cups, have been devised, some of which are j^rovided 
with scaiificating blades. These are, however, too complicated 
for our general practice. When the effect of the cupping is com- 
pleted, the red and tumefied skin, which is exposed as the glass 
is removed, is scarified with instruments ad hoc, as the lancet or 
the bistoury, and the cup is immediately reappHed over the same 
spot. The blood then escapes freely from the incisions, and con- 
tinues to flow until the cup is filled and removed. 

{d) Leeches are not as frequently used in veterinary sui-gery 
as they might be with profit. They are well adapted to small 
animals, such as dogs, whose fine and vascvdar skin yields readily 
to their apphcation. For applying them the skin is first smeared 
with a little milk, sugar, or blood, and the leech, placed in a small 
glass, or cup, or clean pill-box, is brought in contact with the skin 
by reversing the cup or box upon the chosen place. Usually it 
attaches itself at once, and remains until it becomes gorged with 
blood, when it voluntarily releases its hold. Sometimes, however, 
it is better to place them upon a thick compress, moistened with 
tepid water, and to apply this over the skin. In applying them 
on the leg it is a good plan to cover them with a cloth, secured 
with a string tied about the leg above and below, forming a sort 
of bag. 

When the animal fails to drop off, after being thoroughly 
gorged, a sprinkle of salt speedily causes him to release his hold. 
The succeeding hemorrhage will ordinarily cease after a short 



520 



OPEBATIONS ON THE CIECULATORY SYSTEM. 



time without aid, but if it is desirable to continue it, the parts may 
be fomented with warm water, or covered with a warm poultice. 
(e) Bleedhig at the Palate. — Bleeding in this region of the 
mouth is done by a division of the capillary network which rests 
between the mucous membrane and the fibrous coat which lines 
the bones forming the palate. 

The bones represented by the inferior face of the palatine pro- 
cess of the great maxillary bone, and the posterior face of the 
short process of the anterior maxillary, are covered with a fibrous 
coat, which extends over their whole surface and the cartilage 
that fills up the incisive sHt. On each side of the palate run the 
palato-labial arteries, which, forward, form 
an arch, and anastomose together, and give 
rise to a single branch, which enters the in- 
cisive canal formed by the internal face of 
the two small maxillaries. The veins, which 
are very numerous, form a large network 
which fills the space left between these two 
large arteries. The whole is covered by the 
mucous membrane, which is white, rosy, 
thick, adherent to the fibrous coat, and 
showing a number of rugse, about twenty, 
curved forward and diminishing posteriorly 
in size and prominence. Anteriorly they are 
very large, by reason of the presence of a 
certain amount of cellular tissue, which di- 
minishes by degrees, from before backward. 
The anastomosis of the arteries takes place 
about on a level with the thii-d rugse of the palatine surface, and 
it is, therefore, posterior to this that the bleeding must be per- 
formed to avoid wounding the artery. 

The instrument required is the simple bistoury, or the one rep- 
resented in figure 451. The operator, facing the animal, and hold- 
ing the tongue with the left hand, draws it out of the mouth on 
the right side, and with the edge of the knife turned backward, 
makes a small incision from before backward, in the middle of the 
palate between the fourth and fifth rugse. There is no danger of 
wounding the arteries if the incision is made at the proper place 
and on the median line. When that is the case, the hemorrhage, 
continuing for a variable length of time, subsides by degrees. 




Fig. 450.— Circulation 
of the Palate, m, Pala- 
tine mucoua membrane 
s, grooves of the palate; 
a, palato-labial artery. 



CAPILLARY BLEEDING. 



521 





Fig. 451.— Lancet to Bleed at the Palate. 

If, on the contrary, an artery lias been divided and the flow of 
blood becomes sufficiently abundant and continuous to become 
alarming, it becomes necessary to employ hemostatic means. 
These may be a small sponge comi^ressed or moistened with cold 
water or an astringent solution ; or, if necessary, a pad of oakum 
can be appHed and secured with a bandage passed through the 
mouth and around the maxillary bone, and tied on the face. It 
can also be accompHshed by means of a peculiar bit, represented 
in Fig. 452. This bit has a small board in its middle, and on each 
side of the bar two straps, one to 
act as the check-piece of a bridle, 
the other being passed over the 
nose where they are buckled to- 
gether more or less tightly. The 

board of the bar is padded, and ^0 453. -Apparatus to Apply Pressure 

is applied directly over the place *<* ^^^p ^^^ Bleeding at the Palate, 
of the incision. The pressure should be continued for several 
hours. 

This operation was first recommended in cases of stomatitis, 
in the peculiar form known by the unmeaning name of lampas, 
but is resorted to for a much better purpose in apoplectic conges- 
tion of the head. 

(/) Bleeding at the Coronet. — In the " Dictionary of Veterin- 
ary Medicine and Surgery," Bouley says: "There exists on each 
side of the coronet, a rich superficial venous plexus resting on the 
cartilaginous plates of tha foot, formed at this point by the union 
of numerous veins of the digital region. These veins are united 
by large communicating vessels, running on the anterior and 
posterior faces of the second phalanx. Nothing is easier than 
to open one of these vessels by plunging the point of a bistoury 
through the skin ; the puncture being followed by an abundant 
flow of blood, and, if it is repeated, a large bleeding, quite as 
abundant as that obtained by the opening of another large vein, 



522 OPERATIONS ON THE CIRCULATORY SYSTEM. 

can be gained. But it is not a matter of indifference whether the 
puncture is made in front or behind, or upon the sides of the re- 
gion. It must never be made on the sides, because of the danger 
of injuring the cartilage, several cases of cartilaginous quittor 
having been known which were attributable to no other cause than 
bleeding on the side of the coronet. In front the operation is less 
dangerous, although a wound of the tendon of the anterior exten- 
sion of the phalanges is possible. It is safer to bleed on the pos- 
terior part of the coronet, where no danger can be looked for. 

This bleeding has been principally recommended as a local 
operation in cases of acute laminitis. 

{g) Bleeding on the Foot. — The toe is the part selected when 
bleeding is performed on the foot. It is an operation which has 
been known for many years, and under vaiious forms, and with 
different applications has been described by Vrrgilius, Columelle, 
Absyrtus and Vegetius. It consists in the incision and removal 
of a portion of the sole of the foot. It is indicated in all cases 
where local bleeding is justified, and has, therefore, been recom- 
mended in all congestions and inflammations of the foot, such as 
bruises, burned soles and acute laminitis, though in this last case 
its execution is rendered difficult by the unwiUingness of the ani- 
mal to support its weight on one leg dvoing the operation. There 
are several ways of bleeding at the toe. 

1st. The Chahert Method. — A special shoe must first be pre- 
pared; it may be simply an ordinary shoe notched on its inner 
border, which, vdthout being removed, permits both the opera- 
tion of bleeding and the subsequent application of a dressing. 
In operating, the sole is pared out and a groove 
made between the point of the frog and the toe of 
the wall, with a drawing-knife, until the soft tis- 
sues are reached. An incision is then made with 
the curved bistoury at the bottom of the groove, 
between the wall and the inferior border of the os ^^^ 453_siioefor 
pedis, and an incision made dividing all the ves- the Bleeding at the 
sels that come in contact with the instrument. 1^^'^^T^^^f.^ !,^ 

Chabert s Method. 

"VVTien the flow of blood has been sufficient, the 
hemorrhage is suppressed by a compressing dressing of oakum 
kept in place by bandages, or with plates, according to the condi- 
tion of the foot, and whether it had been shod with the notched 
shoe, or had remained entirely shoeless. 




SURGICAL HEMOSTASIA. 523 

2d. The Valet Method. — After the preparation of the foot, as 
with the other method, a groove is made. It is posterior and 
parallel to the line which marks the separation of the wall and the 
sole, and the incision is made transversely, with a bistom-y or a 
sage-knife. It is usually followed by a good flow of blood. An 
ordinary shoe is then placed on the foot, and a compressing dress- 
ing of oakum put on and kept in place by plates. 

3d. Crepiii's Method. — The difference between this and the 
other processes consists in making the incision with a narrow draw- 
ing-knife, which provides a larger opening for the escape of the 
blood. A wide-webbed shoe, with a padding of oakum over the 
wound, suffices to control the hemorrhage. 

AH of these methods have the same object in view, but many 
veterinarians prefer to make the incision a little back of the line 
separating the sole from the wall, and right at the toe, and they 
sometimes remove a small portion of the sole with the sage-knife 
or the bistoury. 

The di'essing which is required in these cases must be care- 
fully applied, as protruding granulations may sometimes make 
their appearance, and interfere with the cicatrizing process. If 
the hemorrhage which accomiDanies the operation should be con- 
sidered insufficient, it can be stimulated by placing the animal in 
a foot-bath of blood-warm water. 

SUKGICAL HEMOSTASIA. 

The extraneous hemorrhage, whether it be avoidable or un- 
avoidable, which may occur dvuing an operation, forms one of 
the most embarrassing of the interferences to which the sur- 
geon is liable, not only from the difficulties it interposes in the 
way of the success of the operation, by disturbing his manipula- 
tions, but as well, sometimes, by the effect of the loss of blood 
upon the patient. It may happen, indeed, that instead of ceasing 
spontaneously, or yielding to the effects of the ordinary dressings, 
the hemorrhage becomes so obstinately persistent as in itself to 
constitute a serious, and, if unsubdued, a fatal accident. It be- 
comes necessary thei'efore for the operator, as one of the jDractical 
elementary incidents of his calling, to be always prepared in an 
emergent case to arrest the rebellious circulation by promj^t and 
efficient measures. Hemorrhage being an essential danger in all 



524 OPERATIONS ON THE CIRCULATORY SYSTEM. 

operations of considerable magnitude, the means of subduing it 
should always, especially in cases of that class, be included among 
the customary instruments and appliances of the working surgeon. 
The flow may proceed from any of the blood vessels, the arteries, 
however, from the nature of their functions and the force of their 
action, requiring more frequently and more particularly the appH- 
cation of precautionary and remedial measures. 

Temporary or Preventive Hemostasia. 

This becomes necessary as an occasional expedient, when the 
presence of the blood is likely to become an obstacle to the opera- 
tion, and the preventive means may be appHed either before or 
during its performance. Included under this general head is the 
cu'cular compression, or Ugation en tnasse, when the situation and 
the form of the region render it practicable. The effect of this 
being the flattening or collapse of the vessels, and the temporary 
closure of their cahbre, one of the necessary conditions of its suc- 
cessful application, especially with the superficial vessels, is that 
they should be situated near enough to some structure sufficiently 
hard and solid to furnish an unyielding j^oiiit appici to the com- 
pressing agent. If, from the position of the artery, no such point 
of resistance can be made available among the surrounding parts, 
resistance can be estabUshed by a double pressiu-e made in op- 
posite directions, in such a manner that the compressing powers 
can furnish mutual supjDort, each to the other. By this plan com- 
pression can be efi'ected in ionr diiferent ways. 

1st. J^y Digital I^ressure. — "When this can be applied and 
proves STifficient, it is the simplest and the best mode. While it 
serves to obstruct the ciraulation, its action is limited to the ves- 
sel which alone needs it, and the tissues are not contused by the 
pressure; it can, moreover, be suspended or renewed at will, and 
can be managed by an assistant who may be placed in a position in 
which interference with the operator can be entirely obviated, and, 
indeed, can sometimes be performed by the surgeon himself. It 
is obtained by j)ressing the vessel with the tips of the fingers 
placed either vertically upon the vessel itself, or along its course ; 
and only such a moderate degree of force need be employed as will 
prove sufficient to close the calibre of the vessel, without fatiguing 
the hand by unnecessary pressure. 



SURGICAL HEMOSTASIA. 



525 



2d. Conipressio7i with the Circular Ligature. — Either a band- 
age or a circular string of sufficient strength may be employed in 
this method. If needed upon the leg, it should be placed upon 
the lower part of the limb, either dry and moderately tight, or 
moistened with cold water. If kept in place for a certain length 
of time previous to an operation, the effect will be to so reduce 
the force of the circulation in that part as to render the perform- 
ance comparatively a bloodless one. This proceeding is often 
associated in veterinary practice with the operation of neurotomy. 
In operations upon the foot, comparatively perfect hemostasia 
may be obtained by circumscribing the coronet with a ligature 




Fig. 454.— The Adstrictor of Brogniez. 

formed of a strong circular string, tightly drawn, but as a substi- 
tute for this, a special instrument has been invented by Brogniez, 
which he calls the adstrictor, which seciu'es the same results. 

3d. Comj^ression by the Tourniquet. — Tha adstrictor of Brog- 
niez is but a peculiar form of tourniquet, which is composed of 
two oval cushions or pads supported by metallic plates, and se- 
cured on the inner face of a circular band adjustable as to its 




Fig. 455.— Tourniquet. 

length, and secured by a common buckle. This band is buckled 
around the leg, and the pressure is made by the pads, which are 
laid directly over the course of the vessel. 

4th. Compression by JEsmarcJc's Method. — Another mode of 
compression, borrowed from human surgery, that of Professor Es- 
marck, is designed to wholly prevent the loss of blood, and enable 
the surgeon to perform a perfectly dry or bloodless operation. It 



526 OPERATIONS ON THE CIECULATOKY SYSTEM. 

consists of a roller of India rubber, to be so applied around the 
seat of tbe operation as to cause the blood to recede toward the 
center of the body, its return being prevented by firmly placing 
a ligature just above the point of incision. The pressure pro- 
duced by this band can be regulated by means of a tom-niquet, 
or a piece of elastic tubing, or an ordinary string that may be 
twisted with a stick. This mode of compression is adapted to 
cases of amputation of the limbs and of the tail, or the removal of 
tumors. 

Permanent, or Definite Hemostasia. 

The arrest of hemorrhage may become necessary at any step 
of an operation, but it is ordinarily when it has been completed 
that the indication must be fulfilled. It is true that in many in- 
stances, even after extensive lesions, the hemorrhage will cease 
spontaneously, but it is equally true that at other times special 
interference becomes a necessity. If the hemorrhage is capillary, 
the surgeon may safely overlook it, and leave it to subside under 
the influence of the retractihty of the tissues ; but if it is of ve- 
nous origin, it cannot be safely left to spontaneous action. Still, 
usually it is only when one of the larger veins is the seat of the 
bleeding that danger becomes imminent, as with those situated 
near the center of the cu'ciolatory system ; but serious accidents 
are seldom to be feared. If the vein is cut across, moderate pres- 
sure upon the orifice will generally insure the formation of a clot 
which will constitute a sufficient plug, or if the vein is opened 
longitudinally by a lateral incision, pressure at the point of the 
wound, though not strong enough wholly to stop the circulation 
within the vessel, may stni be sufficient to assure the rapid obliter- 
ation of the wound. But when large veins or arteries are opened, 
or even when the capillary hemorrhage is usually abundant, more 
complicated means of hemostasia must be resorted to, and not 
only applied carefully and securely, but also with celerity. The 
means of obtaining permanent hemostasia are of two kinds — one 
taking effect through the physico-chemical action of special agents, 
the other including those which are known as surgical means 
proper. 

Physico-Chemical Hemostatics. 

Among these must be considered the refrigerants, absorbe7its, 
astringents or styptics, and potential and actual cauterization. 



SURGICAL HEMOSTASIA. 527 

1st. Refrigerants. — The agents included in this class act 
almost exclusively by depriving the parts upon which they are 
applied of their heat, and in producing a certain excitation upon 
the vaso-motor nerves, followed by a toxic contraction of the mus- 
cular fibres of the vessels, and the diminution, or sometimes the 
complete arrest, of the bloody flow. Their action is principally 
efficacious on vessels of small cahbre, such as the capillaries. 

Cold water, snow, cracked ice, and the very volatile Uquids, as 
ether, chloroform, and freezing mixtures, fiU an important place in 
this category. In veterinary surgery, cold water, being the sim- 
plest, the most accessible and abundant, and the easiest to apply, 
heads the list. It is used in the form of douches, baths, lotions 
and injections, or by means of compresses, pads, or cushions of 
oakum laid upon the seat of hemorrhage. The saline mixtures, 
and the snow or cracked ice, are placed in cloths, bags or blad- 
ders, but their action must be watched in order to obviate the 
possibility of congelation and mortification of the tissues, quite a 
possible result of excessive refrigeration. 

Refrigerants are generally considered as forming the least ef- 
fective of hemostatics, but their facility of appHcation has brought 
them into common use. They are principally indicated against 
external capillary bleeding, or that which escapes from a small 
vessel, but would generally prove insufficient against a hemor- 
rhage from a large vessel. They may, however, prove advanta- 
geous against some internal hemorrhages, which, though they 
may be controllable by other direct means, yet can be reached by 
the water without difficulty or danger, and act directly or by con- 
tinuity in producing the necessary contraction. In this manner, 
injections into the nasal cavities, or the uterus, or rectum are 
often efficacious in arresting a hemorrhagic flow suddenly occur- 
ring. But in any case, refrigerants should be applied with care, 
and their effect watched. If they are allowed to remain too long 
in place, or the temperature be too low, they may induce an in- 
flammatory reaction and local gangrene, or produce other dan- 
gerous general effects upon the internal economy. On the other 
hand, if imperfectly applied, and without a sufficient degree of 
cold, their action, ah'eady weak, will become a mere useless nega- 
tion, if not worse. Between these two extremes there is a middle 
course, which the competent surgeon will be able to observe by 
exercising his discretion, and an appeal to his own experience. 



528 OPERATIONS ON THE CIRCULATOEY SYSTEM. 

2d. A bsorbents. — Hemostatic absorbents proper are agents 
which, by their capillary action suck up or soak in the sanguineous 
element from traumatic surfaces, and having their structure 
thickened and condensed by the presence of this contained liquid, 
coagvdated in their mass, oppose thereby an invincible obstacle to 
the escape of the blood. Oakum, charpie, punk, spider-webs, 
flour, fuller's earth, sponge, and various vegetable powders be- 
long to this catalogue of medicaments. Oakum, which is the 
substance which meets with general favor and is most commonly 
used, is applied in the form of balls, dry, or soaked in cold water, 
and packed over or into the depth of a wound, and kept in place 
with bandages or compresses. 

Compressed sponge has proved, in our hands, an excellent 
hemostat, not only in capillary bleeding, but in that also of me- 
dium-sized vessels. There is, however, an objection to its use in 
the fact of its liabihty to become adherent to the tissues with 
which it is in contact, and the consequent danger of renewing the 
hemorrhage when removing it. 

3d. Astringents, or /Styptics. — These agents produce the co- 
agulation of the blood, by a chemical action, resulting from the 
combination of the astringent's substance with the living tissues. 
Their action differs essentially from that of the refrigerants in 
the fact that they possess the special property of producing, by 
their power of fibrillar astriction, the occlusion of the vessels 
through the coagulation of the blood in their interior. 

Astringents are used in both the solid and the liquid form. 
Burnt alum in powder, and certain vegetable powders, belong to 
the first class. The solution of sulphate of iron, sulphate of 
copper, alum, acetate of lead, alcoholized water, solution of tannic 
acid, etc., are included in the second. They must be judiciously 
used, however, because of their liability sometimes to excite local 
inflammations, more or less active. The action of the liquid as- 
tringents is deeper, more energetic, more lasting, and more dur- 
able than that of the solid, and they are for that reason sometimes 
more reliable for the control of hemorrhages from large vessels. 
Their consistency renders them, of course, alone available for 
moistening compresses, balls, the tampon, or pads of any descrip- 
tion. The most powerful of this class is the perchloride of iron, 
which is remarkable for its power of coagulating the blood almost 
instantaneously. "When applied with oakum upon a bleeding sur- 



SUKGICAIi HEMOSTASIA. 



529 



face it forms, with the blood, a blackish magma, and a resisting, 
strongly-adherent clot in the cavity of the vessel. 

4th. Fotential Caustics. — The chemical astringents have gen- 
erally the same mode of action. Upon being placed in contact 
with the tissues they enter into combination with their elements 
and form a coagulum, and it is the presence of this clot which 
produces the hemostatic effect. They are but little used, how- 
ever, in veterinary practice. The nitrate of silver, some of the 
mineral acids, as sulphuric, nitric, or arsenious, or bichloride of 
mercury, are the potential caustics which are occasionally used, 
though it should always be with great caution, in view of the 
possible danger of producing an excessive effect. 

5th. Actual Cauterization. — Cauterization with the hot iron 
is the oldest and principal hemostatic in use in the surgical treat- 
ment of the domestic animals, and in many instances may be made 
to supersede all the chemical agents we have considered, more 
especially in cases of capillary hemorrhage. It is appHed with 
the iron heated to a white heat, and laid upon the bleeding sur- 
face, where it immediately creates a thick, impermeable eschar, 
adherent to the wound, and offering an insurmountable barrier 
to the escape of the blood. 

To obtain all the effect desired the wound must be thoroughly 
free from all extraneous substances, liquid or soHd, that nothing 
may interfere with the rapid formation of the eschar. The blood 
should be well soaked out, a plug of oakum firmly pressed upon 
the wound, and the iron pressed perpendicularly upon the tissues ; 
this rapidly forms the eschar. The application of the cautery 
must be continued for a few seconds only, on accovmt of its Ua- 
bility, while cooling off, to adhere to the tissues and to the eschar, 
with the consequent risk of reopening the wound and renewing 
the hemorrhage upon attempting its removal. It is better if the 
eschar is not sufficiently thick, after a first appUcation, to renew 
it a second, or even a third time, always taking the same precau- 
tions, and being careful to avoid contact with sound tissues. 

In this operation it is essential that the temperatvire of the 
cautery should be at its maximum. Half-heated, or cooled off by 
the blood, not only is the appHcation more painful, but the effects 
are incomplete and the hemorrhage is likely to return. If the 
blood escapes too freely, or coagulates too slowly, the eschar not 
forming, it may sometimes become necessary to carbonize the 



530 OPERATIONS ON THE CIKCULATOEY SYSTEM. 

bleeding surface by meaBS of some combustible substance which 
will furnish more soUd materials for the protective scar. A loop 
of hair, or some pulverized rosin, placed upon the wound, and 
burnt with the cautery, often fulfills the requirements. For hem- 
orrhage from parts below the surface, the edges of the wound 
must be separated before the cautery is introduced, to prevent its 
cooling before reaching the proper point of application. When 
the eschar is well formed and established it should be left without 
interference to complete the process of sloughing. 

The thermo-cautery, with which the required heat can be re- 
tained at a uniform degree, is one of the best instruments for 
the application of this mode of hemostasia, there being no need 
of removing it until an eschar of sufficient thickness has been ob- 
tained. 

Stjbgical Hemostatics. 

Among the numerous surgical means of obtaining both per- 
manent and definitive hemostasis, there are three which principally 
merit our attention : compression, ligature and torsion. 

(A) Compression. — We have already referred to this method 
while considering the subject of temporary hemostasia. There 
are cases in which it acts as an excellent mode of permanently 
controlling hemorrhage, whether proceeding from arterial, venous 
or capillary sources, and equally whether from a large surface or 
from a deep cavity, where the origin of the hemorrhage cannot be 
distinctly located. Still, for arterial hemorrhages it is only effica- 
cious for vessels of small or medium size, or when the wounds are 
of small dimensions. There are secondary circumstances which 
determine the designations of certain variations of pressure. One 
is the situation of the vessel, relatively to that of the bleeding 
orifice, when the pressure, to be effective, must therefore be direct 
or lateral, and with the latter, either mediate or immediate. Some- 
times, again, it is applied at a distance from the bleeding point, 
and in an indirect manner, and involves an alternative between 
plugging and direct com^yression. It is appHed to the wound 
itself when the vessel has been cut directly across. It is usually 
effected by covering or filling the wound with a dressing of 
balls of oakum applied directly upon the bleeding orifice, and 
covering these with pads, increasing in dimensions as they become 
more superficial. The whole apparatus is submitted to pressure 



SURGICAL HEMOSTASIA. 



531 



by approximating the edges of the wound, as much as possible, 
by means of interrupted, pin, or a quill suture ; or sometimes 
a circular bandage of dry or compressed sponge, cut iato small 
pieces, may be used in the same manner as the oakum with ex- 
cellent effect, especially when the hemorrhage is abundant, or 
ligation become impracticable. 

The objection to the mode of compression, generally speaking, 
is its Hability to become loosened in consequence of the softened 
and yielding condition of the surrounding tissues. For this rea- 
son the mode of applying the force directly is not often practiced, 
or, at least, is adopted only when the hemorrhages are small and 
controllable by slight pressure, or in case of the section of an in- 
compressible artery, Hke that of a bone. 

Tn order to increase the effect of direct pressure the sui'geon 
sometimes has recourse to the joint use of some of the physico- 
chemical hemostatics before mentioned. 

(a) Immediate Lateral Compression. — This is practiced 
against hemorrhages due to lateral wounds of blood vessels, and 
is applied directly upon the opening in the vessel. The method 
of its application does not differ from that of direct compression, 
and it is Hable to the same objections in its irritating effect upon 
the surface of the wound and consequent interference with cica- 
trization, and the danger of a renewal of the bleeding. More- 
over, if the vessel is without a solid resting-place, and there is no 
sufficient resisting point, hemorrhage is not arrested. But again, 
in a contrary condition, it may be followed by gangrene or the 
obhteration of the vessel, and if the wound is of such a form that 
this last accident cannot be avoided it is better to have immediate 
recourse to the ligature. It remains, then, that this mode of hem- 
ostasia is only advisable when the wound is small and the artery 
small and superficial, or in such a position that it cannot be ligated. 

Immediate lateral compression, however, can be made with 
great benefit with the finger, upon the wound, pressing with the 
necessary force to prevent the escape of the blood, without clos- 
ing the calibre of the vessel. The finger is kept in position for 
one or two hours, with an occasional inspection to discover whether 
the hemorrhage has ceased, and when it is removed there remains 
but a simple wound, easy to dress. 

This mode of compression has the advantage of obviating the 
accidents that may occur from excessive external pressure main- 



532 OPERATIONS ON THE CIRCULATORY SYSTEM. 

tained by ligatures and dressings, such as the division of the skin 
and the possibihty of gangrene. The value of this measure of 
digital compression may be estimated by the fact of its successful 
application to a vessel of the dimensions of the carotid artery in 
a case of a wound by pricking. 

(b) Mediate Lateral Compression. — The compression here is 
applied outside of the solution of continuity, in such a manner as 
to leave a certain thickness of the tissues between the injured ves- 
sel and the compressing apparatus. It may take effect either 
directly upon the wound itself, or elsewhere along the course of 
the vessel. It can be effectively made only upon superficial ves- 
sels, principally arteries which, Hke those of the extremities, lie 
upon or near enough to resisting surfaces to furnish a means of 
support to the pressure. The manner in which temporary and 
permanent hemostasia can be obtained is the same, excepting that 
the cords, bandages and tourniquet are replaced by graded com- 
presses, supported by rollers or appropriate bandages, which are 
continued only during the existing necessity. 

The objection to this hemostatic method, and which it shares 
with all the other processes of compression, is, that when a large 
vessel is to be compressed, and a certain amount of force becomes 
necessary, other tissues, with other vessels, veins and nerves alike, 
must participate in the same pressure, and, as a consequence, dis- 
turbances of varying degrees of severity will occur in parts situ- 
ated beyond the compressed surface, proportioned to the duration 
of their exjDosure to the acting cause. Hence the indication, in 
applying the apparatus, to begin at the peripheric portion of the 
region, to carry it toward the center, in passing over the wound 
ah-eady protected and covered by the balls, pads or compresses, 
which constitute the true means of compression. 

The principal objections to this process of hemostasia can be 
obviated by leaving on the apparatus only for the minimum time 
necessary to obtain the cicatrization of the wound of the vessel, 
which will, of course, vary according to circumstances, and will 
be especially influenced by the consideration whether the calibre 
of the vessel is to be preserved or obliterated. 

If the vessel be a small one, the wound of small dimensions, and 
the continuity of the channel is to be preserved, a few hours will 
be sufficient ; or, if otherwise, it is to be obHterated, one or two 
days will be required, or even at times one or two weeks. 



SURGICAL HEMOSTASIA. 533 

(c) Plugging. — This mode of compression is chosen as a per- 
manent hemostatic to arrest hemorrhages which occur upon the 
surface of natural cavities, or upon wounds where the injured 
vessel cannot be reached. This is done with balls, or pledgets of 
oakum or sponge, carried with a forceps to the bottom of the 
cavities, or with sachets, arranged in the manner of the tampon, 
impregnated with an astringent solution or a cold mixture, the 
whole being kept in place by the dressing which closes the cavity. 
It is used in cases of epistaxis and hemorrhages from the uterus, 
or those following castration. But with all its advantages it is an 
uncertaia mode, and opposes but a sUght obstacle to the hemor- 
rhage ; besides which it irritates, by the pressure of the plugging 
material on the parts with which it is in contact, where it acts in 
the manner of a foreign body, which in fact it is, giving rise to 
some pain, and perhaps stimulating muscular contractions, and 
thus exciting the hemorrhage anew. However, these objections 
are not of sufficient weight to contra-indicate its employment 
as a ready and efficacious means of hemostasia, or to prevent 
it from being wisely appreciated and largely employed by the 
surgeon. 

(B) — Ligature. — The Hgature is the typical and obvious means 
of hemostasia — the hemostat par excellence — perfect in its sim- 
phcity, though consisting simply in tying a circular thread or 
cord around the wounded vessel with sufficient tension to close its 
channel, suppress the circulation, and convert the tube into a 
cord. It can be applied either on the cut extremity of an artery, 
or upon its continuity. It is seldom appHed upon veins, however, 
from its Uability to induce phlebitis, but still, it is resorted to in 
wounds of large veins, or when the hemorrhage cannot be con- 
trolled by other means. » 

As with compression, ligature may be immediate or m^ediate, 
and may also be divided into temporary and permanent — tem- 
p)orary, when its continuance depends upon some contingency — 
permanent^ when it is to remain until it is eUminated by suppura- 
tion, or becomes organized and absorbed, as when the ligating 
thread is composed of some special animal fibre — which is the 
kind most commonly used. 

The instruments required for this operation are : tenaculum, 
aneurism needle, Hgature materials, ordinary dissecting or bull- 
dog forceps, scalpel or bistoury, and the grooved director. 



584 



OPEKATIONS ON THE CIRCULATORY SYSTEM. 



The kind of forceps used are known as artery forceps, and 
are of numerous varieties. 




Fig. 457.— Cooper Needles, or Tenaculum. 

The tenaculum, or aneurism needle, is a kind of blunt tenacu- 
lum with an eye at its end, and is used to seize or secure the 
vessels. 

The suture materials are linen thread, silk, animal hgatures, 
such as catgut or tendinous fibrilla, and sometimes very fine me- 
tallic wire. Ordinary linen thread and silk, well waxed, are most 
commonly used in veterinary practice. 

(a) Immediate Ligature. — This is the surest of hemostatic 
means. It is applied principally upon large arteries surrounded 
only by their cellular sheaths, and a difference is made in applying 



SURGICAL HEMOSTASIA. 535 

it between vessels which are perfectly intact and those which 
have been partially cut through or otherwise injured. 

The immediate ligating of an artery entirely divided includes 
but two steps : the prehension of the artery and the adjustment 
of the ligatiu'e. 

When drawn out of its position with the proper forceps the 
artery must be carefully examined for possible adhesions, and 
especially any nervous threads which may be attached to its sur- 
face — aU of which must be dissected. 

In placing the ligature many operators carry the thread, form- 
ing a loop, with the forceps, and on seizing the artery and seeing 
that it is clear from the surrounding tissues, they shp the loop 
down over the instrument upon the vessel, to be tied by an assist- 
ant. The apparent simphcity of this movement is deceptive ; too 
often the loop of the ligature adheres to the wound, the ends roll 
over themselves and one another, the ligature cannot be properly 
placed over the vessel, and the knot is tied over the forceps before 
the thread has reached the artery. To avoid this it is better, when 
the vessel has been well secured and isolated, to have the assistant 
apply the Hgature by its middle upon the jaws of the forceps, be- 
hind the hand of the surgeon holding them, in order to be free in 
his movements. Then making first a simple knot, without twist- 
ing the thread, and tying it close to the forceps, he then, with the 




Pig. 458.— Applying the Ligature. 

thumbs, pushes the thread further along the artery, and ties it by 
pressing the thumbs together with sufficient firmness to rupture 
the internal membrane of the vessel. If the wound be deep, in- 
stead of the thumbs both indexes are used to carry the thread 
along the artery and tie it. The forceps is then removed and 



536 OPEKATIONS ON THE CIRCULATOKY SYSTEM. 




Fig. 460.— Improperly-made Knot. 



a second straight knot is made (Fig, 459). The knot represented 
in Fig. 460 is improperly made and liable to become loosened. 
The extremities of the thread are left of a sufficient length to 
allow their being tiu'ned toward the most dependent part of the 
wound. If they are cut too short they are Hable to become loose 
in the tissues, and be covered or concealed by the granulations and 
become the center of a suppurative gathering. Ligatures intended 
to remain in the tissues, must be made of animal material. 

The wound of an artery always involves the application of a 
ligature on both extremities of the course, the central and the 
peripheric. 

Where the artery cannot easily be raised or dissected from the 
tissues into which it is retracted, the pointed tenaculum can be 
used to draw it out of its position ; this instrument is more suita- 
ble for small than large vessels, the coat of which it is liable to tear. 

In the immediate ligating of an intact artery, and without a 
solution of continuity, the vessel is exposed by means of an in- 
cision, either parallel or sometimes oblique, and at others perpen- 
dicular to the artery, according to its situation and the nature of 
the subjacent tissues, carefully noting any projections of the 
bones, muscles, or tendons which can be made available as points 
de repere; observing, indeed, aU the anatomical connections exist- 
ing between the different structiires. When the artery has been 
nearly reached, in order to avoid injuring it, it should be separated 
by dissection with the forceps and the bistoury from the tissues 
covering it, or by introducing a blunt, grooved director under 
them, as a guide, and dividing them with the knife. The sheath 
of the vessel is also carefully divided and separated from the ves- 
sel itself, which is then carefully isolated from its vein or surround- 
ing adhesion, and the blunt-eyed tenaculum, or the aneurism 



SUKGICAL HEMOSTASIA. 537 

needle passed under it. Sometimes this is easily done, but in 
other cases the density of the connective tissue surrounding the 
artery is too great to allow the needle to pass readily under it. 
in which case the obstacle can be removed by scraping it away 
with the finger-nail, which will obviate the application of extra trac- 
tion upon the vessel. The ligatui'e can then be adjusted around 
the vessel by means of the tenaculum, and the operation completed 
as usual. 

(b) Mediate Ligature. — This operation comprises including 
in the ligature of the vessel a certain portion of the surrounding 
tissue — a portion which should be as small as possible. 

It is done with a curved needle and a ligatiu'e of single or 
double waxed thread or silk. The needle is introduced into the 
thickness of the tissues, at a small distance from the artery, and 
passed around it with the ligature, which should be firmly tied in 
the usual way. 

The ligatui'e is quite painful in consequence of the pi*essui*e it 
makes upon the nervous fibres which accompany the artery, and it 
is less safe than the immediate operation, exposing the vessel diir- 
ing its performance to the risk of wounds from the needle, and 
requiring, besides, a stronger traction upon the ligature and the 
knot, from the increased bulk of tissues involved ; and there is, 
again, great uncertainty as to securing a sufiicient division of the 
internal and middle coats of the artery. For these reasons it is 
less adapted to large than to small arteries. 

The effects produced by the application of a ligature are not 
wholly mechanical. It is also followed by certain pecuHar changes 
in the condition of the vessel, and by specific inflammatory phe- 
nomena which result in the permanent obliteration of the tubulai* 
character of the artery. 

When an artery is tied with the hgature the internal and mid- 
dle coats of the vessel ai'e also divided by the compressing thread, 
and by their retraction above and below it they form a double 
cone, the apices of which rest on the ligated spot, the external 
coat resisting and arresting the flow of the blood. A clot is then 
formed, and the irritation produced by the pressure of the ligature 
stimulating the proliferation of the cellular elements of the walls 
of the vessel, adhesions are soon established between them and 
the coagulated blood, and the termination is the solidification of 
the former tube. 



538 OPERATIONS ON THE CIRCULATOEY SYSTEM. 

The presence of the hgature and its effect on the surroundings 
of the blood vessel give rise to a process of elimination, by which, 
after a certain time, the Hgating thread is expelled, carrying with 
it the vascular stump situated beyond the Hgature. At the same 
time, and while these phenomena are taking place outwardly, the 
clot, adhering more and more to the vascular surfaces, soon be- 
comes the seat of peculiar absorbent changes, and gradually dimin- 
ishing in size, at length disappears. 

As the resorption of the clot takes place the walls of the ves- 
sel contract until at length the caUber of the artery becomes en- 
tirely obliterated, and the former tubular canal is transformed into 
a fibrous cord, extending from the point of the ligature to the 
nearest collateral vessel. 

This obliterating process of the arterial canal may, however, 
be defeated by the interference of too active an inflammation, pro- 
ducing the premature sloughing of the ligature, or by the exist- 
ence in too close proximity to the point of ligation of a collateral 
arterial branch. In both cases hemorrhages may follow ; in the 
first, because the adhesion of the clot is imperfect, and in the 
second, because no clot has been formed. 

(C) ToESioN. — This hemostatic process has been known from an 
early date, but was not methodically described until about forty 
or fifty years ago, by Amussat, who recommended it in preference 
to the method of ligation. But daily experience has demonstrated 
its inferiority, and proved it to be a less powerful hemostatic meas- 
ure than that of the ligature, and, moreover, that it is only avail- 
able for hemorrhages occurring in small vessels. 

There are several ways of applying torsion. Among the 
principal is that recognized by Amussat. It requh^es four forceps, 
two ordinary anatomical, another whose branches are terminated 
by smooth cylindrical jaws, and the fourth the artery -twisting 
forceps. The artery is held with one of the ordinary forceps ; 
with the other the tissues surrounding it are separated from it ; 
then the twisting forceps grasp the artery at its extremity in 
place of the one first used, keeping it out of the wound, and when 
thus secured the instrument with the smooth transverse jaws is 
applied above it, close to the tissues, and firmly pressed upon the 
coats of the artery. In this position, the twisting forceps is given 
a rotary motion upon its axis, as if the vessel were to be rolled 
over its extremities, and is twisted upon itself by seven or eight 



SURGICAL HEMOSTASIA. 



539 




Fig. 461.— Artery Forceps for Torsion. 

turns. The smooth-jaw forceps is then removed, and the stump 
of the artery is released and pushed into the tissues, unless the 
torsion has been sufficiently severe to produce the laceration and 
retraction of the vessel. As the result of these manipulations the 
two internal coats of the torn artery retract upon themselves and 
the external coat is elongated and rolled upon itself — all in such 
a manner that the clot is arrested by the retracted internal mem- 



540 OPEKATIONS ON THE CIRCULATOEY SYSTEM. 

branes, as well as by the support contributed by the pseudo-plug- 
ging, which results from the twisting of the external coat. 

This process is a complicated one, but it has been modified in 
several ways. In one process only two ordinary artery forceps are 
used ; one applied at some distance from the end of the artery, 
transversely to its axis, and the other holding the vessel by its end 
in continuity to its length. Keeping the first tight on the vessel, 
the torsion is made by ten or twelve complete rotations of the 
second. 

Another still simpler mode consists in grasping the mouth of 
the bleeding vessel, and giving it a number of rotations with a 
strong artery forceps, the artery being thus twisted without tear- 
ing or entirely dividing it. Nothwithstanding all these modifica- 
tions, torsion is not applicable to large arteries, and cannot super- 
sede the ligature. It is slower in performance ; it is more painful ; 
it requires a greater isolation of the vessel ; and the possibility of 
untwisting, and with it, secondary hemorrhage, is always to be 
feared. 



CHAPTER XI. 

OPERATIONS ON THE NERVOUS 
SYSTEM. 

PLANTAR NEUROTOMY. 

Although the word neurotomy, when correctly defined, means, 
in a general sense, the dissection of nerves, it has in surgery an- 
other signification, and is apiDlied indifferently to describe the di- 
vision, the resection or the amputation of a nerve, according to 
the special manipulations of a given case. In veterinary surgery, 
it is held to be strictly apphcable to the operation which consists 
in the dissection and removal of a portion of a nerve, and as the 
present chapter proposes to treat princij)ally of affections of the 
foot, it is simply correct to employ the tei'm plantar as a prefix to 
the title, as we have done. The design of the operation is the 
destruction of the susceptibility of the region or organ imphcated 
in the treatment, and to subdue the pain, if not permanently, at 
least for a period of time sufficient to restore a working animal to 
his abOity to labor, which, without such a relieving operation, 
would have been lost to usefulness and comfort. 

This curious and important operation has a comparatively 
recent history. It is of English origin, two British surgeons 
claiming priority in its performance. These rival contestants are 
Moorcroft and SeweU, who put it in practice, the former in India, 
and the latter in England, at about the same time. After its in- 
troduction, it was frequently performed by EngHsh veterinarians, 
among whose names occur those of Goodwyn, Coleman, Percivall, 
Spooner and others. 

Its introduction on the continent was in France, and is credi- 
ted to Girard, Jr., who described it in 1824, and from that date it 
continued to be a subject of experiment at the hands of many 
veterinarians. We say experiment, because it was only after a 



542 OPERATIONS ON THE NERVOUS SYSTEM. 

long series of trials, and as the result of much discussion of its 
merit and value, that it secured an a£&rmative verdict from the 
magnates of veterinary practice, and became an estabhshed posi- 
tion in our science. Yet the objections which it encountered in 
Europe have not to this day been wholly eradicated, and on this 
side of the Atlantic there are few practitioners who still decUne 
to give it their confidence and adopt it in their practice. The 
opposition which it has encountered is founded principally upon 
the failures, the accidents and the unfortunate sequelae, which 
were not rarely met with during the period immediately following 
its original introduction. These objections we now proceed to 
consider. 

Stumbling has been mentioned as one of the first effects of 
the loss of the tactile function of the foot, by the destruction of 
its sensibility. The animal which has lost the soUdity and the 
certainty of his gait, will only after a long time become accus- 
tomed to the proper use of the comparatively inert mass repre- 
sented by so indispensable a part of his organization as his foot, 
so complicated in its arrangements and adaptations, and so per- 
fect a portion of his anatomical structure before the extirpation 
of its nervous sense. And yet, while this condition of stumb- 
ling must be fvilly appreciated by those whose anatomical knowl- 
edge enables them to take into full and careful consideration 
the physiology of the part, and who have verified the objection 
from their own observation, there are also veterinarians of large 
practice and long experience who have operated in numerous 
cases, even upon animals used for fast work, where the muscular 
effort is of a comparatively violent character, who have met with 
the accident only in very rare and strictly exceptional cases. It 
must rationally be inferred that an unskilled operation of such a 
character would leave the patient in a condition of which an awk- 
ward and stumbling gait would be but a natural and inevitable 
sign. But it would also be in the course of a natural and healthy 
reaction for a horse to educate himself rapidly to the situation, 
and acquire a new certainty of movement and confidence in the 
use of his feet, which would soon restore him to his former abil- 
ity to labor. 

The casting off of the hoof, as a complication or termination 
of the operation in neurotomized horses, is one necessarily of a 
fatal character. This fatality has, in some instances, followed the 



PLANTAR NEUROTOMY. 543 

operation within a pei'iod of from one to two months, but on the 
other hand its occui'rence has been deferred in other animals for 
years. Evidently, these varying results must be considered as 
the effect of different and quite disconnected causes. The truth 
is, indeed, that in the first instance it is due to a gangi'enous dis- 
organization of the tissues within the foot, and in the second, in- 
stead of being the result of insufficient vitahty, or arising from 
lack of nutrition of the parts, it is more probably the consequence 
of the uni-egulated force of the concussion when the foot strikes 
the earth — unregulated because of the loss of the discriminating 
instinct foi'merly exercised, but now lost with the missing nerve- 
consciousness which once controlled all the movements of the limb. 
It covdd scarcely happen that such a condition of things should 
fail, after years of continuance, to encounter some susceptible 
temper in which to exhibit its baleful influence. 

A reason which must not be overlooked in relation to the cast- 
ing off of the hoof is the fact that in. the neurotomized animal 
the essential sjTnptoms of the first development of any lesions 
which might give rise to it, are missing. The first of these symp- 
toms is the pain which is normally manifested by the lameness, 
and for that reason it is that the care and attention required by 
the foot of a neurotomized horse are at once so important and so 
commonly overlooked and omitted. But without ignoring the 
possibihty of this accident, the question is presented, whether it 
is of such common occim-ence that its frequency constitutes a 
cogent reason for abohshing the operation. 

Our answer to this, founded on the showing of the record, 
must be given in the negative. To quote but one among many 
authorities — Professor Nocard says that out of more than one 
thousand operations, he has never met with that accident. For 
ourselves, in a practice of many years, with a number of neurot- 
omy cases which we can count by the hundreds, we also have 
never encountered it. In the only case we have seen, other causes 
existed in the form of suppurative corns, which were overlooked, 
and which were, moreover, compHcated with gangrene of the vel- 
vety and podophyllous tissues. 

The Softening of the JPerforans Tendon and its subsequent 
rupture, is also a very severe sequelae of neurotomy. This may 
take place almost immediately after the operation, or it may be 
postponed until after a few months, when the animal has resumed 



544: OPERATIONS ON THE NERVOUS SYSTEM. 

his work. It has, indeed, been charged to undue haste, in com- 
pelling the animal to labor without allowing sufficient time for the 
healing process to be completed, and it is also alleged that it is a 
consequence of the performance of the operation on both sides of 
the leg at once. It is both a possible theory and a plausible argu- 
ment that the failure of the tendon is the result of the shocks in- 
flicted upon it while in a condition of disease and unconsciousness, 
and this may explain the possibility of the accident without any 
reference to the circumstance of putting the animal to work. But 
this falls far short of proving that the neurotomy exercised any 
potent agency in bringing on the softening and rupture. And as 
to the effect of performing the double simultaneous operation, our 
opinion wiU be readily iuferred from the fact which we here state, 
that out of the large number of neurotomy cases which have passed 
through our hands, we have seen but a single case of softening 
and rupture of the perforans tendon, and that was associated with 
a fracture at the os pedis. The horse had been operated on upon 
both feet, and on both sides at once, for navicular disease of old 
standing, and on the third day following he was found in his box 
standing on both fetlocks. He was destroyed and it was found 
that the tendons of the perforans had given away in both feet, with 
a fracture of the navicular bone and os pedis on one foot, and of 
the OS pedis alone at the semi-lunar crest on the other. It is our 
constant habit to operate on both sides, and with this sole excep- 
tion, we have never met with softening of the tendons. 

Springhalt. — Beugnot and Renner report cases in which the 
performance of the operation on the hind feet was followed by the 
appearance of springhalt. 

In addition to the points we have been discussing, other 
alleged objections exist, which may claim superior force and value, 
but there are none among them of sufficient weight, in view of 
the many benefits realized from the operation, to justify its repu- 
diation and abandonment. 

Among these may be mentioned the theory that the foot de- 
prived of its sensibOity by neurotomy is more exposed to the se- 
quelae of pricks, contused wovmds, corns, etc., from the circum- 
stance that there is no betrayal or visible manifestation of the 
lameness which is usually indicative of lesions of that organ. 

It is further objected that in many instances the lameness 
shows, sooner or later, a tendency to relapse. But there is httle 



PLANTAK NEUROTOMY. 



545 



validity in this allegation, from the known fact that in a majority 
of cases its early reciUTence is mainly due to imperfect methods or 
an unskillful performance of the oj)eration, and cannot, for that 
reason, be considered a proper incident of the case, but simply 
an accident, which may be obviated by care and precaution, and 
in judging the transaction, must be eliminated from the argu- 
ment. 

Probably the most important and most nearly valid objection 
is that the suppression of the nervous influence has more or less 
effect upon the nutrition of the digital region. Notwithstanding 
the observations of Braael, the question of the direct influence of 
the digital nerves upon the nutrition of that region is a point 
which has not yet been thoroughly comprehended by our physiol- 
ogists. For this region this objection, and the points involved in 
it, call for further study, and it is nearly certain that when it has 
received this the end will be the removal of the reproach brought 
against neurotomy of interfering with the vegetative life of the 
digital region. 

Having thus examined the objections which have been urged 
against neurotomy, a consideration of the advantages claimed for 
it will come next in order of mention. Leaving out of view the 
few failures to which the operation, in common with every human 
act or endeavor, whether in great matters or small, is from the 
constitution of things, Hable, we proceed to the facts which demon- 
strate the usefulness and value of the treatment, with a descrip- 
tion of the various modes of procedxu'e practiced by difi"erent sur- 
geons. The facts of the direct and successful results which be- 
yond question have been secured, are so numerous and so patent, 
and they so far counter-balance aU possible accidents, that no 
conceivable array of abortive cases, if reported truly and vnth- 
out prejudice, can impair their force and significance. It would 
be impossible to reach even a proximate estimate of the value 
saved and the loss prevented by the restoration of unnumbered 
useless and suflfering animals to comfort and usefulness. 

And these are what might be called the positive or direct ad- 
vantages of neurotomy. But besides these, there are other advan- 
tages in the secondary effects of the operation, of which the im- 
portance cannot be ignored, especially when they are commended 
to our attention by such authority as that of Professor Nocard, of 
Alfort, when he says : " In several cases I have noticed a great 



546 OPERATIONS ON THE NERVOUS SYSTEM. 

diminution in the size of exostoses (ringbones), which we treated 
by neurotomy ; . . . " and again, " Neurotomy, by removing the 
pain existing in the posterior jDarts of the foot, removes the cause 
for knuckling, and prevents the retraction of the tendons ;" and 
further, " It prevents also the serious accidents, so frequent after 
firing of the coronet, sloughing of the skin, cartilaginous qmttor, 
necrosis of tendons or ligaments, opening of joints, etc., all being 
accidents likely to f oUow the severe cauterization which, to be suc- 
cessful, is required in the treatment of those exostoses." 

Speaking of these advantages, Zundel says: "In rare cases, 
besides the removal of the lameness, the recovery of the disease 
which gave rise to it, may also be observed. Thus, after neuro- 
tomy, contracted feet have, after a few months, regained their nor- 
mal form, and exostoses have stopped their growth and even di- 
minished in size." 

Having thus considered this matter, both pro and con, giving 
on one side the objections urged against it, with the alleged facts 
and inferences with which its opponents seek to maintain their ar- 
gument, and on the other hand, shown the reasons which influence 
the friends of the operation in advocating and putting it in prac- 
tice, with their statement of its utility and the important bene- 
fits it is capable of conferring, we are prepared to examine into 
the conditions which indicate or counter-indicate this particular 
method of surgical interference. 

Bouley, speaking of its indications, said: "When the digital 
region is the seat of a chronic disease, manifested by pain and 
continued lameness, provided the alterations of structvire are not 
of such a nature as to interfere mechanically with the execution 
of the function of the region, neurotomy is indicated." And 
speaking of lameness, the seat of which is not located, Messrs. 
Hardy and Hugues go farther, for with them " neurotomy can and 
ought to be performed when a lameness from an unknown cause, 
and whose nature is not recognized, has for a period of more 
than three months resisted ordinary therapeutical and surgical 
means." 

Taking these as axiomatic rules, laid down by such authorities, 
and substantiated by the results obtained by their observance, it 
becomes evident that in aU cases of lameness of the nature de- 
scribed by these writers, or, to repeat, lameness and pain from an 
unknown cause, neurotomy is the indication, and if it fails to cure 



PLANTAB NEUKOTOMY. 



547 



the undiscovered disease, it will, at least, relieve the lameness, if 
not in all, yet still in a large majority of the cases. 

In contraction of the heels, or in feet subject to chronic corns, 
as result of their conformation, and in some cases of chronic 
laminitis, where there is either no alteration of structure, or very 
little, as weU as in keraphylocele, here also neurotomy is bene- 
ficial. But it is principally in navicular disease that its advan- 
tages are best illustrated. And next to these, as best adapted to 
prove and exemphfy its benefits, must be classed ringbones and 
sidebones, the characteristic exostoses of the digital region. 

Excellent results have followed it when performed for the rehef 
of the lameness which often supervenes upon severe injuries, or 
operations about the foot, such as fractiu'es of the phalanges, crush- 
ing of hoof, or any of the sometimes violent acts of svu-gical inter- 
ference necessitated by the diseases of that region. The question 
has even been discussed of the probability of obtaining beneficial 
results in tetanus, following traumatic lesions of the foot ; especially 
in punctm^ed wounds. 

A glance at the counter-indications of neurotomy will furnish 
a plausible explanation of the objections alleged against it in its 
earher history. In the fact that the complications now recognized 
as thus related to it were then unknown, and consequently un- 
recognized, and the operation performed notwithstanding, we 
at once discovered a sufficient reason for the failures and bad 
results of the treatment, and the consequent odium into which it 
naturally fell. It was not yet adequately comprehended — it was 
misapplied — it was, perhaps, unskilfully performed — it failed. A 
very logical formula; but it ought not to have been denounced. 

Neurotomy is indicated in navicvJar disease, and for some in 
the very incipiency of the attack, aU other modes of treatment 
being only palliative and temporary, and when it has advanced to 
its chronic stage an operation will be of little advantage, or whoUy 
unsuccessful, if at this period the bone has become extensively 
diseased, and the tendon reduced to the condition of a mere mem- 
braneous peUicle. It is also contra-indicated in all forms of acute 
inflammation of the foot ; in badly formed feet, such as the flat or 
pumiced of chronic laminitis ; and, again, when the lameness origi- 
nates in a very large exostosis or other bony disease likely to be- 
come a mechanical obstruction to the movements of the articula- 
tion, or to the play of tendons, or to produce anchylosis. To 



548 



OPERATIONS ON THE NEEVOITS SYSTEM. 



resume, it may be said with Bouley, " one must not ask from neu- 
rotomy more than it can grant, by applying it to cases where the 
lameness must necessarily persist, even after the removal of pain 
in the diseased parts." 

One important practical point in the performance of the opera- 
tion is the determination of the place where it is to be performed. 
A reference to the anatomical disposition of these plantar nerves 
will aid us here. In the forelegs both the external and inter- 
nal plantar nerves form branches about equal in size, running on 
each side of the leg, with an identical disposition. Each of these 
nervous branches is situated along the tendon of the perforans 




Pig. 462.— Plantar Nerves in Digital Region. 
P, plantar nerve ; A, original of the digital nerves ; B B B, cartilaginous branch; 
C C C, cutaneous branch; D, digital artery, with the nerve hack of it; E E, ramifications 
of the cartilaginous and cutaneous branch ; F P, bulbous branches ; G, Transverse 
branches back of the fetlock Joint: V, digital vein. 



PLANTAK NEUROTOMY. 



549 



muscles, then, at a point a little above the fetlock, they ramify 
and divide into three branches, or digital nerves proper ; one prin- 
cipal, posterior or continuation of the main trunk, running toward 




no. 463.— Plantar Nerve on the Posterior Face of the Phalanges. 
P. plantar nerve; A, origin of the plantar nerve above the sesamoids; B, cartilagi- 
nous branch; C, cutaneous branch ; D, digital artery; H, branch to the cartilaginous 
bulbs— sometimes absent; I, branch of the plantar cushion; K, transversal coronary 
branch; M, podophyllous ramification; O, pre-plantar nerve; Q, branch to the patilobe 
eminence; R, arterial branches; V, vein which is sometimes found running back of the 
plantar nerve. 

the middle part of the lateral cartilage of the foot, under which 
it passes ; a second, anterior, smaller than the posterior, which is 
divided toward the middle of the first phalanx, into several 
branches, ramifying in the tendon and other parts of the anterior 
region of the foot ; and a third, or middle branch, which goes to 
the coronary band and podophyllous tissue. The consideration 
of the relation held by these j)lantar and digital branches to the 
blood vessels constitutes an important practical point in the opera- 
tion. Artery, vein and nerve descend on both sides of the fet- 
lock, in such a manner that the vein is situated in front, the artery 



550 OPERATIONS ON THE NERVOUS SYSTEM. 

in the middle, and the nerve behind — the vein being on a plane 
somewhat more superficial than the artery, which is a little deeper. 
Consequently the operation may be performed at any one of four 
points, and on either side of the leg. 

These are, first, above the fetlock, on the plantar nerve proper ; 
second, below the fetlock, on the posterior branch ; third, below 
the fetlock, also on the anterior branch ; and fourth, according to 
Nocard, above the fetlock, on the anterior branch. The first or 
second of these locations is more often selected for the operation, 
and forms either the high or low process. 

For each of these operations there is a point of selection. In 
the high process this is immediately above the fetlock, where the 
nerve is most superficial and most easUy exposed, on the outside 
border, and a little in front of the perforans tendon. In the low 
method it is below the fetlock, in the middle of that part of the 
coronet region where a depression is felt between the tendon and 
the first phalanx. 

The question of preference between the high and low opera- 
tions has been made the subject of much discussion, and it re- 
mains still unsolved. With many the high operation is that which 
yields the best results; others hold that the object especially con- 
templated in any given case must determine the point as the oc- 
casion presents itself. It is only just to say, however, that the ma- 
jority of practitioners prefer the high operation ; not only because 
it is easier to perform, but also because it is more likely to be 
successful. 

Personally, we believe that the high operation, with some 
few exceptional cases, is that which will prove almost generally 
beneficial. 

The instruments necessary are, a pair of scissors, a convex 
bistoury or scalpel (we prefer the latter), a narrow, straight bis- 
toury, two dissecting forceps, a pair of blunt tenaculums, with 
an elastic band (Fig. 464), an aneurism tenaculum (Fig. 465), 
needles, thread and sponges. Those who are familiar with the 
operation highly commend a new instrument, the neurotome (Fig. 
466), which has been invented to take the place of the straight 
bistoury. 

Neurotomy is a simple operation, but a very painful one, and 
it is necessary, therefore, to have the animal well secured from the 
commencement of his struggles, which may endanger both himself 



PLANTAR NEUROTOMY. 



551 




Fig. 464.— Blunt 
Tenaculum, with 
Elastic Band. 



Fig. 465.— Blunt 
Tenaculum, 




Fig. 466.— Right and Left Neurotomes. 

and the surgeon and his attendants. We fully agree with the 
admitted rule that animals undergoing surgical operations should 
be thrown and properly secured. We, with other practitioners, 
however, have succeeded so well in obtaining complete local an- 
esthesia by the use of cocaine, that it has enabled us to perform 
the operation in the standing position. We, nevertheless, can 
scarcely see the necessity for general anesthesia when, as we be- 
Ueve, the intense pain which occurs the moment of the division 
of the nerve can be mitigated by careful local anesthesia after the 
nerve is exposed, should the operator think it necessary. A careful 
consideration of the various methods recommended for securing 
an animal, when cast for operation, has induced us to adopt the 
following as the simplest, the safest and the easiest to apply and 
control : The animal is thrown upon the side of the leg which is 
to be operated upon, and, both legs being bound together above 
the knee with a few twists of a flat rope in the form of a figure 8, 
the leg to be treated is removed from the hobble and drawn 



552 OPERATIONS ON THE NERVOUS SYSTEM. 

forward with a rope attached to the foot. In this manner the 
inside of the leg is first treated, after which the animal is turned 
over and the process repeated on the outside. If the operation is 
to be performed on both legs, the patient may be thrown on either 
side indifferently, and his legs secured as before described. The 
under leg is then first released and dealt with on the inside ; then 
rebound to the hobble and the upper leg liberated, and the process 
repeated on the outside. The horse is then turned over, and the 
inside of the second leg operated upon is neurotomized and 
returned to its hobble ; and finally, the vipper leg, which was on 
the under side at the beginning, is operated on upon the outside. 

Our mode of operating may differ somewhat from those prac- 
ticed by others, but the general plan is the same. 

The patient, having always been prepared by local treatment 
of his fetlocks, which have been soaked and firmly bandaged for 
twenty-four hours, is cast and secured, as before stated, the hair 
is closely clipped with the scissors, and the parts thoroughly 
washed with an antiseptic solution (bichloride of mercury). 
Having carefully felt for the location of the nerve, which, in many 
cases, can be discovered by feeling the pulsations of the artery, 
an incision is made through the skin with, if possible, one stroke 
of the convex bistoury, measuring from an inch to an inch and a 
half in length. It is an advantage to have the incision slightly 
oblique to the direction of the nerve. Then, with a forceps in one 
hand, and the handle of a bistoury or scalpel in the other, the 
cellular tissue is lacerated from the edges of the incision, in order 
to allow the application of the two blunt rubbered tenaculums, 
which, when in position, hold open the wound ; or sometimes 
threads are used instead, being passed through the edges of the 
wound and tied on the opposite side of the leg. If the incision 
has been made in the proper place, after sponging away the trifling 
hemorrhage which obscures the wound, the nerve may be seen at 
the bottom, or it may be found surrounded with more or less 
condensed cellular tissue, and the next move is its dissection. 
With a dissecting forceps in each hand, we firmly grasp the con- 
nective tissue with one, while with the other we tear it away 
immediately over the nerve, removing it by two or three small 
portions at a time until the nerve is exposed, lying more or less 
closely to the artery. Then, with a gentle two-and-fro movement, 
we isolate the nerve from its attachments with the cellular 



PLANTAK NEUROTOMY. 553 

structure, and when it is loosened, a fact easily recognized by 
an apparent shrinking in its length, it is ready for the division. 
At times we pass under it the blunt aneurism tenaculum, carry- 
ing a thread with which to secure it, and when secured, passing 
the pointed bistoury under it, we divide it with a single upward 
stroke of the instrument. In other instances, instead of the ten- 
aculum and thread, we use the neurotome, which, having a curved, 
blunt end, enables us at once to isolate the nerve, and with a 
simple motion of the sharp edge to divide it from below upward. 
Upon making the section the lower end of the nerve is secured 
with forceps, drawn out of the wound, separated from its adhe- 
sions by scraping it with the bistoury, and when a portion about 
an inch or an inch and a half in length has been dissected, and 
the resection is completed, either with the neau'otomy knife or the 
bistoury, the wound is to be cleansed with antiseptic washes. 

The edges are in a very few instances secured by a stitch of 
suture, but we often prefer a simple antiseptic dressing and a 
bandage. 

There is, of course, no doubt that animals will often struggle 
during the operation, and especially at the moment when the Hga- 
ture is tightened upon the nerve, or when the nerve is divided, 
but the pain in either case is so transient that while we appreciate 
the value of anesthesia, we cannot recommend, in ordinary prac- 
tice, general etherization or chloroformization. If it is necessary 
to have recourse, as some do, to the tourniquet, or of any other 
means, to control a possible hemorrhage, a large experience in the 
practice of this operation has failed to show us a single case 
where such practice would have been of advantage. 

The various details of the operation are substantially the same, 
both for the high and the low process. It must be borne in mind, 
however, when operating below the fetlock, that the nerve is often 
concealed by a little fibrous band, which a careless operator might 
mistake for the nerve itself. 

There is probably no special attention required as supple- 
mental to the operation. The wound heals more or less rapidly 
by first or second intention, and, as a rule, after two or three 
weeks there are no signs of the occurrence excepting a simple 
linear cicatrix remaining. Of the accidents which may be en- 
countered during the operation, hemorrhage is the most import- 
ant. Generally this is referrible to an error on the part of the 



554 OPEBATIONS ON THE NERVOUS SYSTEM. 

operator in dividing the artery or the vein, and usually it is not 
dangerous, though it may stiU prove very troublesome. If the 
artery is divided the ligature must be appHed on the truncated 
ends ; if the vein, pressure will be sufficient. 

The last imj^ortant point involved in a case of neurotomy is 
the length of time required by a neurotomized animal to recuper- 
ate before he can safely return to his work. It is undeniable that 
to a too hasty return of the patient to his accustomed labor most 
of the objections and alleged complications of the operation may 
be traced, and for this reason the answer to the question how 
long a rest shall follow the operation must be as long as circum- 
stances will jyet'init. 

Zundel, Gourdon, Fleming, and others, make a month the 
minimum period within which no considerable exertion should be 
undergone; we would sometimes be still more Hberal in allotting 
the length of the vacation. 



CHAPTER Xn. 

OPERATIONS ON THE GENITO-URINARY 
APPARATUS. 

CATHETERISM OF THE URETHRA. 

The object of this oj)eration is the exploration of the interior 
of the bladder, and consists in the introduction of a catheter, 
species of canula, or through the urethral canal into that oi'gan, 
for the purpose of ascertaining and removing its contents. Al- 
though the lU'ethra of the male has great length, with an acute 
curve at the ischial arch, the operation is not a difficult one. It 
is described as the partial and the complete, according to the dis- 
tance to which the instrument is inserted into the canal, being 
partial when the catheter is pushed in the urethra only as far as 
the pelvic portion of the passage, but complete when it is carried 
completely into the bladder. 

The operation is employed in animals of both sexes, and is 
indicated in cases of retention of urine, due either to the pressure 
of calculi, or to the spasmodic contractions of the bladder, which 
accompany some cases of colic ; or, again, when in attacks of 
paraplegia the animal is unable to micturate naturally. It also 
constitutes one of the first steps of the operation in urethrotomy, 
in cystotomy, and in lithotrity. 

We shall consider the operations separately as performed in 
males and in females. 

In Males. — The catheter used in veterinary practice for male 
solipeds is composed of a tube of wire, twisted in close spirals, 
and covered with a species of thin oH-cloth, making the outer sur- 
face perfectly smooth, and forming a perfect canula. It is fur- 
nished with a stylet made of flexible rush broom, or whalebone, 
which can be readily withdrawn from the cavity of the instru- 
ment. 

Metallic catheters, invented first by Brogniez, and improved 
on the plan of those used in human medicine, may also be ob- 



556 



OPEBATIONS ON THE GENITO-URINAKY APPARATUS. 




Fig. 467.— Catheter. 



tained, but they are not in as general use as the simpler and 
cheaper kind above described. India-rubber instruments, more 
or less pliable, constructed on the same general plan, are also 
made. 

In solipeds, urethral catheterism can be performed either when 
the animal is standing or in the recumbent position. In the first 
case he is kept quiet by the application of a twitch on one lip and 
of the hobbles on his hind legs. This done, the first step is to 
secure control of the penis by drawing it out of the sheath, which 
must first have been thoroughly cleaned and washed to remove 
all the sebaceous secretion which by its greasy consistency renders 
this step of the operation quite a difficult one, many animals 
resisting the attempt to accomplish this with all their force. But 
by obtaining and retaining a firm hold of the penis above the 
glans, and drawing upon it slowly, firmly and steadily, the resist • 
ance of the animal may be at length overcome, and the organ 
brought into full view. The operator then, guided by the little 
protrusion of the urethral canal, in the middle and a little toward 
the lower border of the glans, carefully introduces the instru- 
ment, which should be freely lubricated with oil or vaseline, 
pushes it slowly toward the ischial arch. When the instrument 



CATHETEKISM OF THE URETHRA. 557 

reaches the ischial space the stylet must be withdrawn in order to 
avoid the difficulty of bending the catheter over the curve formed 
at that point in the urethra. At this moment a gentle but firm 
and steady pressure upon the end of the instrument (easily felt 
at the ischial arch), made by an assistant bending it forward, vrill, 
with a little careful pushing, effect its entrance into the bladder. 
This will, of course, become known at once by the cessation of 
the resistance, and by the escape of the urine which may be con- 
tained in the bladder. 

The removal of the instrument is effected by simply drawing 
it carefully from the passage. 

Sometimes simple pressure over the ischial arch is insufficient, 
and the bending of the instnunent into the proper direction is to 
be made through the rectum, and hence the indication of having 
that organ well emptied before proceeding to the operation. 

The indication of great caution in this operation is suggested 
by a consideration of the fact that (if the canal should chance to 
be of unusually narrow diameter or its walls softened by disease) 
there is sometimes danger of forming false passages, by punctur- 
ing the mucous membrane, and forcing the catheter into the 
erectile tissue which surrounds the urethra. This is an incident 
which, however, can be avoided by removing the stylet from the 
caniila before its introduction into the urethra, the canula itself 
being terminated by a perforated oval bulb, perfectly smooth, and 
thus incapable of inflicting injury. 

In Catheterizing Females, a small catheter may be and is 
sometimes used, but as a rule, the metaUic instrument is prefer- 
able, the conditions of the method, the shortness of the passage 



Fig. 468.— Female Catheter. 



and its comparatively large diameter, with the facility with which 
it can be entered, rendering the metaUic on all accounts more 
eHgible than the composition or the rubber tube. 

The instrument, being lubricated with oil or vaseline, the oper- 
ator, opening the vulva with the left hand, introduces his right, 
holding the instrument, into the vagina, and carries it forward to 
the meatus urinarius, which he can feel at about six or seven 



558 OPERATIONS ON THE GENITO-URINARY APPARATUS. 

inches in front of tlie vulva. While thus holding the instrument, 
he feels, with the middle finger of his right hand, for the mucous 
valvular fold which covers the meatus, pushes the finger tmder it, 
and then, bringing the bulb end of the catheter to the opening of 
the urethra, inserts it into the bladder. 

The accidents that may arise from carelessness, or otherwise, 
in the catheterism of males, are not met with when treating 
females. 

URETHKOTOMY. 

Incisions of the urethral canal are made for various purposes. 
The removal of foreign bodies, usually calculi ; the restoration of 
the suspended power of micturition when is has been caused by 
the closure of the passage ; the estabhshment of an artificial 
urethral opening ; and the penetration of the cavity of the bladder 
when necessary for surgical purposes — these are among the 
reasons for which this important canal is incised by the surgeon. 
It is principally performed on males, the dimensions, aside from 
its shortness, of the urethra in females being, as a rule, ample, 
and the organ sufficiently dilatable for the removal of calculi, 
or other objects, without involving the necessity of an operation. 
Among the males, the ox is the animal which most frequently re- 
quires it, by reason of the peculiar hability of this animal to suffer 
from a constitutional tendency to the formation of calculi and 
the fact that these accretions are often arrested in the urethra, in 
consequence of a peculiar double curvature, or S formation, in the 
penis. 

With horses, it is in some districts quite a common operation. 
In these animals, however, the calculi, though of rare formation, 
are larger and are more generally retained, either in the bladder 
or in the first portion of the urethra. In smaller animals, calculi 
are also quite common and troublesome, especially in dogs, on 
accoimt of the presence of the bony formation in the structure of 
the penis. 

In the horse, the principal operation is performed in the peri- 
neal region, or the part extending on the median line from the 
anus to the scrotum, bounded above and on each side by the 
ischial tuberosities, and below by the flat of the thighs. 

The skin of the perineum is very fine and thin, and is hairless 



UKETHKOTOMY. 



559 




1 1 -Th ^'^•.''^^-^'^^*°°^y°f the Perineal, Anal and Caudal Regions. 

i^-;;:;'°'""°^^'^^°°-°««°yS muscled 4 4-ilter«Vi^^^°^ the coccygeal muscles, 
chio-coccygeal muscles. 6. -Su8DXorvlipi;^«^fJ^°u°^'^''yeeal muscles. 5 5. -Is- 
arteries. 8._Deep caudal vein 8at^&S'''^>,'L''' ^^^^^^ 7 7.-Lateral caudal 

artery lo lO.-Inferior caudaf nei v " i, ^1,^'l'^'f'' ^'"'^''T'- 9— Median caudal 
caudal veins. 12'.-One of the «,7t?«,X!;- , ^^•~,^™P.'^*tic glands. 12 12.-Superflcial 

aponeurosis. 14 14.-b°miUeXanosi8 muscle ^T% 'h~^or'''''' «* the Set^ 
cavernous muscle 17 17 —VinihX^^ muscle. 15.— Sphincter ani 16 16 — Ischln 

t^« P--- ^9J«--BulbLs''o"r'nt?r;rprbi?'artries'' ^.V 't"^?«-'^^°'^ Kentf ^ 
canal for urethrotomy, gi.— Anus. ^^- 80. -Incision of the urethral 



560 OPERATIONS ON THE GENITO-URINARY APPARATUS. 

below the anus, but downward and on the sides, is is covered with 
short hair. Below the skin are found the two principal layers of 
aponeurotic covering, divided into the superficial and the deep. 
The former, of fibro-elastic texture, is the continuation of the dar- 
tos, and covers the perineal region, thinning down as it nears the 
anus, to disappear at the sphincter ani. Its most superficial fibres 
give attachment to a subcutaneous muscular fasiculus, which 
from the splineter ani runs downward to lose itself about three 
inches below. The latter plane, or deep aponeurosis is formed of 
white inextensible fibrous tissues. Intimately adherent by its 
external face to the superficial layer, it covers and unites with the 
accelerator urinse, and the ischio-cavemous muscles, as well as 
with the suspensor and retractor Hgaments of the penis. It then 
passes between the ischio-cavernous and the semi-membranosus, 
to attach itself above on the ischial tuberosity and become lost 
downward on the thighs. Some of its fibres directly surround 
the fixed portion of penis, and join the aponeurosis common to 
all the muscles of the flat of the thigh. 

The suspensor and retractor of the penis form, in the upper 
perineal region, that is, from the anus to the ischial arch, an ex- 
pansion of sufficient width to form a true anatomical layer. Below 
this they represent bands about half an inch wide, situated on the 
median line, and covering the accelerator muscle. They are 
formed of white muscular fibres. The blood-vessels and nerves 
of this region, with the other parts pertaining to the anatomy of 
the urethra, have already been considered. 

The peculiarity that belongs to the penis of ruminants must 
not be overlooked, when the question of urethrotomy in these 
animals is under discussion. Their penis is very long and thin, and 
is surrounded in the perineal region by a complete aponeurotic 
sheath, and on a level with the pubis it has two ciirvatures, which 
give to the organ the form of an S. On a level with the second 
curvature it gives attachment to the suspensory ligaments. The 
free portion of the organ is elongated, strongly filiform, and 
covered by a fine, rosy mucous- membrane. The pecuUarities 
possessed by the penis of the horse do not exist in cattle. 

The operation of urethrotomy is classified and designated with 
reference to the part of the urethra, which is to be divided, and 
this is of cotirse determined by the location of the body to be re- 
moved, making the designations principally regional; and it is 



UKETHROTOMY. 561 

therefore said that tlie operation can be performed in three ways, 
though three jplaces would be the more accurate phrase. 

Thus we have first, the incision at the point of the penis, or 
'preputial urethrotomy ; second, the division in the scrotal region, 
or scrotal urethrotomy ; and third, the incision below the anus, 
or ischial urethrotomy. 

Preputial Ueethkotomy. 
In horses and dogs the urethra becomes more or less con- 
tracted toward the full extremity of the penis, and calculi are 
therefore apt to become arrested in that locality ; in other cases, 
masses of sebaceous matter will collect in the navicular fossa. In 
sheep, saline concretions are found, either in the prepuce or in the 
urethra. All these conditions involve a contingency of surgical 
interference. To remove them in the horse and in dogs, a trans- 
verse incision is made with a bistoury over the spot where the 
presence of the foreign body is detected, and it is readily disposed 
of. If the erratic substance is in the urethra, an incision is made 
through its membranes and it is removed in entirety, or sometimes 
after having been reduced to fragments by means of a probe or 
of a curator. In sheep, the simple amputation is recommended 
by some. The wound made in these cases heals without trouble. 

Scrotal Urethrotomy, 

Scrotal urethrotomy ean be performed either on the front or 
behind the testicles. In cattle it is ordinarily posteriorly that the 
calculus is lodged, more commonly in the second than in the first 
curvature, and hence the indication for selecting this place for the 
operation. Yet there are practitioners who prefer the anterior sec- 
tion, because the penis being more superficial at that place, there 
is less cellular and adipose tissue to be divided before exposing it. 

In either case, the animal is thrown, with the hind leg carried 
forward and secured as for castration. If the operation is to be 
performed behind the testicular mass, an incision is made on the 
median Hne, measuring about three inches in length, the cellular 
tissue divided with the knife or the finger and the penis drawn 
out through the incision. The calculus is extracted through a 
longitudinal incision. The canal should then be examined with a 
probe or bougie, to ascertain whether any more offending bodies 
are present, and if so, they are of course also removed. The 



562 OPEKATIONS ON THE GENITO-URINAKY APPARATUS. 

wound may be either closed by sutures, or, preferably, left without 
interference, to obviate the possible danger of the formation of 
future scrotal abscesses. 

In the pre-scrotal operation, the hair is first cHpped short, and 
an incision made through a transverse fold of the skin, to expose 
the penis. The concluding steps are the same as those in the 
former case. 

It is, however, always advisable, when the animal is secured, 
and before dividing the tissues, to insert the hand into the pre- 
puce to draw out the organ. By thus straightening it and remov- 
ing the S curvature, it is possible, and sometimes occurs, that 
calculi are displaced and extracted without the necessity of resort- 
ing to the knife. 

The urinary fistulas which are among the sequelse of scrotal 
urethrotomy, are of two or three weeks' duration, seldom continu- 
ing longer. Care must be taken to protect the skin from the 
irritation produced by the dripping of the urine through the 
wound. 

Ischial Ueethrotomt. 

This is the most common of the three operations, and is apph- 
cable to all males. 

It is performed vsdthout casting, with the animal hobbled on 
both hind legs and a twitch on his lip. (Fig. 470.) The decubi- 
tal position is seldom required. The free use of cocaine has 
enabled us to operate without any means of restraint, not only in 
horses, but in camels, which are very awkward and uneasy animals 
at the best, and esj)ecially when in the hands and under the knife 
of the surgeon. The insertion of a catheter has been recom- 
mended by many, to serve as a guide to the dissection of the 
urethra, while others prefer the artificial dilatation of the canal 
by the injection of water. In some cases, however, neither of 
these expedients is necessary. The presence of the calculus and 
the dilatation of the urethra above it, by the confined urine, 
greatly assists in the location and puncture of the canal. 

The incision must be made on the main line, on a level with 
the ischiatic arch. The structures to be divided are first, the 
skin, then the subcutaneous cellular tissue, the aponeurotic layers, 
and the accelator urinae; which being completed, a straight 
puncture can be made in the urethra between the two suspen- 
sory ligaments. The incision is then extended upward or down- 



URETHEOTOMY. 



563 




Fig. 470.— Secure for Ischial Urethrotomy. 

ward, as may be required, with the bistoury, guided by the 
grooved director, a blunt bistoury being sometimes chosen from 
the motive of prudence, in order to avoid possible injury to the 
surrounding blood vessels. 

In our experience we have secured very satisfactory results by 
adopting the method recommended by Bouley, of making one 
comprehensive pimctiu'e, which penetrates the canal without any 
preliminary dissection of the incumbent parts, esjoecially when a 
catheter has been placed in the urethra for the guidance of the 
knife. The hemorrhage, which generally accompanies this mode 
of operation is of no great importance, often subsiding of itself, 
and seldom requiring external hemostatic applications. 

We beUeve it to be the better course, when the object in view 
has been realized, to leave the wound to itself, without interfering 
with the healing process by seeking to facHitate it by the appHca- 
tion of sutures. It gradually granulates and closes without any 
special care beyond the observance of cleanliness and the neces- 
sary measures to prevent irritation of the skin from the contact 
of the urine as it "leaks " through the wound. 

When the urethra has been opened, in whatever region of the 
penis the offending foreign body may be lodged, it is readily 



564 



OPEKATIONS ON THE GENITO-UKINAKY APPARATUS. 




Straight. Curved. 

Figs. 471, 472.— Forceps to remove Foreign Bodies from the Bladder. 

extracted witli straight or curve forceps. These can also be em- 
ployed to secure those of comparatively small size that may be 
found in the bladder, and answer very well likewise for those 
masses of a sedimentary nature that are commonly seen in mares. 

There may sometime be some peculiar pathological conditions 
which render it necessary to prevent the closing of the wound in 
cases of ischial urethrotomy, and when the formation of a perma- 
nent artifical opening should, perhap, be attempted. 

The entire closing of the urethra, in its anterior portion, re- 



UEETHKOTOMY. 



565 



suiting from some special trauma- 
tism would be such a case ; or again, 
when the formation of calculi has 
become an estabhshed constitutional 
habit, and the results of this perver- 
sion of the nutritive and assimilative 
function are always present and con- 
tinually renewed. In view of this 
imfortunate state of things, and to 
prevent the closing of the wound, 
Troeber recommends the use of a 
pecuhar tube, which, when intro- 
duced into the urethra can be per- 
manently retained in place for an 
indefinite length of time (Fig. 473). 
We have attempted the formation 
of an artificial urethral opening, by 
sewing together the mucous mem- 
brane of the canal and the skin, but the results of the experiment 
were of the most transient character. 




Fig. 473.— Tube of Troeber, for Isclual 
Uretbrotomy in Bovines. 



CYSTOTOMY. 

Improperly known also as lithotomy, is an operation which 
consists in the incision of the neck of the bladder to remove cal- 
culi of dimensions too great for removal intact through the 
urethra. This operation has no longer a place in our surgery, 
and, in fact, there is no existing reason for its performance. If a 
calculus is of small or of medium size the neck of the bladder 
can always be sufficiently dilated to permit its passage, and if it 
should be of greater dimensions, and rendered impossible of ex- 
traction by its size, the operation of Hthotrity is always available, 
and in experienced hands as nearly certain and safe as can reason- 
ably be expected. 

LITHOTKITY. 

This term designates the operation of crushing, or piercing, 
or drilling stones in the bladder, in order to reduce them to frag- 
ments, preparatory to their removal by means of forceps or ciu'- 
ates, or by washing them out of the bladder with water. It 
mostly corresponds with, or rather, includes the lithotomy of 



566 



OPEBATIONS ON THE GENITO-URINAEY APPARATUS. 




Fig. 474.— Lithotritor of Guillon. 



human surgery. It was per- 
formed for the first time by 
H. Bouley in 1858, with the 
assistance of a practitioner 
of human surgery, Dr. Guil- 
lon. 

Horses are more specially 
the subjects of this opera- 
tion in cases when the cal- 
culi are too bulky and too 
hard to be broken and re- 
moved with the forceps 
alone. In ruminants, on 
the contrary, vesical calculi, 
though more common, and 
more numerous in single 
animals, are generally of 
sufficiently small size to 
permit the relief of the pa- 
tient by the simple opera- 
tion of urethrotomy. 

The instruments neces- 
sary for this oj)eration are 
the lithotritor, or lithon- 
triptor, with also the crusJi- 
ing forceps. The lithotri- 
tor of GuiUon (Fig. 474), 
or the crushing forceps of 
Bouley (Fig. 475), are those 
generally used. We are con- 
vinced by our experience of 
these instruments that the 
-. principal, and probably the 
only objection that applies 
to them lies against their 
mechanical construction. 
"We consider them to be too 
clumsy, too large and too 
heavy; objections, however, 
which are very easily obvi- 



LITHOTEITY. 



567 



ated by any competent instru- 
ment-maker. 

WMle they must necessa- 
rily possess sufficient power to 
crush the calcuU, we fail to see 
that a proper attention to the 
featiu-es of symmetry, finish, 
and convenience of manipula- 
tion can involve any sacrifice 
of efficiency. The instrument 
can be made to possess ample 
strength, while still more easy 
to handle when introduced in- 
to the bladder through the com- 
paratively small opening of is- 
chial urethrotomy. 

A bivalve speculum (Fig. 
476) to dilate the wound of the 
urethra is sometimes of great 
value. A large syringe, and 
plenty of water, or what is 
better, an irrigator for douches 
to wash out the bladder, will 
complete the series of neces- 
sary instruments. The opera- 
tion is performed with the ani- 
mal in the standing position, 
secured as for urethrotomy, or 
cast if the operator so prefer 
it, and placed under the influ- 
ence of general anesthesia. 

"We borrow from H. Bou- ^^^- 475.— Crushing Forceps of Bouley. 

ley, the father of the operation, his own description of the modus 
operandi : 

Access to the bladder having been obtained by the process 
already described, the essential operation is divided into three 
principal steps : 

1st. The introduction of the lithotritor, and searching for and 
grasping the stone ; 2d, crushing of the calculus ; 3d, removal of 
the fragments. 




568 



0PEKATI0N8 ON THE GENITO-URINAKY APPAEATUS. 




Fig 476.— Bivalve Speculum. 

1st. Introduction of the instrument for searching and grasp- 
ing the stone. — This step varies with, the instrument, as to whether 
the lithotritor or the crushing forceps is used. If the first, the 
instrument, well greased and kept closed, is inserted through the 
urethral incision, with its concavity resting on the convexity of the 
ischial arch, and is pushed obliquely forward and downward 
through the pelvic portion of the urethra and the neck of the 
bladder. "When in this cavity the branches of the instrument are 
opened, and by a shght and slow movement made to traverse the 
cystic space until it comes in contact with the calculus, which then 
drops into the hollow of the branch adopted by its shallow form 
to receive it. The jaws of the instrument are then brought to- 
gether and the stone firmly secured. 

The same description, in every particular, applies to the ma- 
nipulation of the crushing forceps. 

In some cases, however, it is necessary to disarticulate the in- 
struments, and to introduce the branches sej)arately, unitiag them 
when both have been inserted. 

It is important, in every case, to leave a small portion of urine 
in the bladder to facilitate the movement of the stone and aid in 
its seizure without grasping and pinching the lining membrane of 
the organ. If the bladder is empty a portion of water might be 
injected. 

2d. Crushing of the Stone. — This is done by slowly approxi- 
mating the jaws of the instrument. It is not necessary to reduce 
the stone to very minute particles. It will be sufficient if their 
dimensions are not too great to permit their free escape through 
the urethral passage. 

In removing the instrument after accomphshing the crushing, 
a great deal of the comminuted calculus is extracted between its 
jaws. 

3d. JRetnoval of the Fragments. — Dilating the urethral wound 



LITHOTKITY. 



)69 



with the bivalve speculum, a stream of water is then thrown into 
the bladder, either with the syringe or the tube of the irrigator. 
The water ought to be tepid and antisejptic ; and a hand intro- 
duced into the rectum and manipulating the bladder, will facih- 
tate the repulsion of the larger fragments, and the washing out of 
the smaller. The general attention required in all cases of serious 
operations will be necessary after the performance of lithotrity. 
In respect to any special dressing, they are the same as those in- 
dicated in simple urethrotomy. 

Serious, however, as this operation is, it is comparatively free 
from dangerous sequelae. Hemorrhages of easy control have been 
met, luinary abscesses, with infiltration, have occurred, serious 
wounds of the urethra, of the rectum and of the bladder may also 
happen, but they are of rare occurrence, and can be avoided by 
careful manipulation through all the steps of the operation. 

AMPUTATION OF THE PENIS. 

This operation is indicated in the horse when the penis becomes 
the seat of warty growths ; of epithelial, ^papillomatous, or can- 
cerous degenerations ; of fracture ; of paraphymosis, or of paraly- 
sis. Warty growths are usually found covering more or less the 
free part of the penis; or its free extremity; or the glans penis; 
and are also sometimes met with on the inside of the sheath, their 
presence being accompanied with an offensive and very irritating 
sebaceous discharge, becoming at times so painful as to interfere 
with mictiu'ition. They resist the severest forms of treatment, 
and it is not unusvial for them to develojD into forms of a more 
alarming natiu'e, notably those of chancroid degeneration, of 
which, in fact, these epithilial growths are but the seminal origin. 
In other cases the erectile tissue of the glans penis becomes the 
seat of ulceration, extending in depth, spreading in such a manner 
over the penis that the free portion of the organ becomes a mere 
mass of bleeding surface, of m-egular aspect, macerating in the 
pus which abundantly forms, and which escapes with its peculiarity 
of bloody saniousity, with the most repulsive odor and irritating 
effect, rendering the act of micturition most painful and difficult. 
In many instances the animal so dreads to bring his penis out of 
the sheath that he urinates within the cavity formed by the folds 
of the skin, adding another source of irritation to that already 



570 OPERATIONS OX THE GENITO -URINARY APPARATUS. 

existing. And if the penis is still allowed to pass out of the 
sheath, the micturition is made with a crooked stream, which in- 
stead of escaping forward is, on the contrary, discharged back- 
ward. In such a case no treatment will reheve the difficulty but 
the removal of the entire diseased structure. 

In fractures of the penis ; in many conditions of paraphymosis ; 
or in those of paralysis, the organ hangs suspended outside of the 
sheath, and cannot be restored to its cavity. If pushed back it 
soon returns to its abnormal condition, and even if retained by 
artificial means, wiU continue in place only while the means are 
continued to enforce it, becoming displaced agaia whenever the 
restraining agency ceases to operate. This serves to render the 
animal useless, in consequence of its appearance being so repul- 
sive as to preclude his employment in public view. Of course the 
only radical cure for such an ailment is the knife or its equivalent. 

The operation usually consists in the removal of the free por- 
tion of the penis, the necessity for going beyond this seldom 
occurring, yet in order to reach the diseased part it is sometimes 
necessary to divide the sheath along the median line. 

The general anatomy of the organ, as far as it relates to the 
operation, is very simple. The penis it formed by the corpus 




Fig. 477. — Penis in Normal Condition. 

cavernosum, a long, erectile structure, flattened from side to side, 
and grooved on its inferior border for the reception of the corpus 
spongiosum urethrse. Terminated inferiorly by a blunt point, 
this corpus cavernosum dips into the erectUe tissue of the urethra. 
After passing out of the pelvic cavity, by the ischial arch, the 
spongious portion of this canal, is received into the groove of the 
corpus cavernosum, at the anterior part, and also extends beyond 
it. The mucous membrane is covered externally by the tissue 



AMPUTATION OF THE PENIS. 



571 



which gives to this part of the urethra its name, and this erectile 
tissue terminates anteriorly in an enlargement, more or less 
developed, forming the head of the penis, or the glans penis. 
The urethra proper protrudes a Httle below the center of the 
head of the penis, and shows in a cavity underneath, the urethral 
fossa, more or less filled with a sebaceous secretion. The blood 
vessels which ramify in these erectile structiu'es are the two dor- 
sal arteries of the penis, anterior and posterior, and the veins, 
which form large branches, running also upon the dorsal border 
of the organ. 

Zundel very wisely insists upon two principal conditions (to 
which we shall again refer) to realize in the operation, first to 
manage to leave a free means of exit for the urine, by cutting 
away less of the urethra than that of the cavernous body, and 
second, to avoid the hemorrhage, which is especially liable to take 
place in horses, on account of the abundant circulation in the 
erectile tissues. 

The animal if to be placed in the recumbent position, as in the 
operation for castration, that is, on the left side ; or it may prove 
advantageous to place him on his back. 

Five modes of operation are described by different writers on 
the subject — 1st, the ligature; 2d, cauterization; 3d, excision; 
4th, by scraping; and 5th, by cnishing. 

As an adjunct to the various instruments which these different 
operations may require, metallic catheters are also necessary. 

The Ligature. — The catheter being introduced into the urethra, 
beyond the point where the amputation is to be made, a strong 
ligature is applied at that point and tightened sufficiently, if pos- 
sible, to strangulate the portion of the penis which is to be 
removed. After from twenty-four to forty-eight hours, the 
external layers of the tissues will have become mortified, even to 
a certain depth in the penis, and a new ligature is then applied, 
and strongly tied like the first one. The deeper layers of the 
penis are also, after a day or two longer, so mortified that they 
continue attached to the tissues above the Hgature only by a 
small particle, which can be divided with the knife. The catheter 
may then be removed or it may be allowed to remain in place a 
few days longer. No special subsequent treatment is required. 
If, after a few days, micturation seems to become difficult, the 
urethral opening may be enlarged by the introduction of a bougie 



572 OPERATIONS ON THE GENITO-URINAEY APPARATUS. 

or a catheter, or again enlarged by an incision with the bistourj'. 
Instead of the ordinary string, an elastic ligature may be sub- 
stituted with the advantage of maintaining an uninterrupted pres- 
sure upon the tissues up to the moment when mortification is 
established in the part to be amputated. 

Cauterization. — No catheter is required with this plan. Two 
ligatures are apj)lied, one anterior, by which the penis is kept out 
of its sheath, and one posterior, acting as a hemostatic, placed 
above the point where the division is to be made. The operator 
then with a flat and sharp cautery, heated to white heat, makes a 
complete section of the penis. 

But, says Zundel, " as the urethra is especially dehcate and 
sensitive, it is better, in order to avoid its retraction, to separate 
it from the cavernous body about half an inch in front of the place 
where the section is made." A hollow bougie of india rubber 
inserted into the urethra will also prevent its contraction. 

Professor Nocard has recommended the use of the galvano- 
cautery, to obtain an easier division of the tissues, a more perfect 
hemostatis and to shorten the duration of the operation. 

Excision. — After introducing a metallic catheter, a rapid sec- 
tion of the organ is made by a single stroke of the knife. Again, 
says Zundel, " when the urethra is reached, it must be dissected 
a little forward, toward the glans penis, and caused to protrude 
about half an inch beyond the point cauterized." 

Scraping of the penis. — This method, which was put in prac- 
tice in 1829 by Moiroud and Delafond, consists in scraping the 
penis with a bistoury, in such a way that the remaining portion of 
the organ forms a cone, with its apex formed by the urethra. A 
catheter may be introduced into the canal previous to the opera- 
tion and left in place for awhile ; or again, it may, if thought 
proper, be entirely dispensed with. This mode precludes the 
danger of hemorrhage. 

Crushing. — By operating with the ecraseur, the amputation is 
perfected without danger of hemorrhage. The chain of the 
instrument is applied at the point of amputation, and by slow and 
gradual action, cuts through the tissues until the diseased part 
drops off. The danger attending this method is that the chain 
may break during the |)rocess, in consequence of the resistance of 
the cavernous tissue. This accident has certainly been encoun- 
tered by many practitioners, and we have ourselves witnessed it 



AMPUTATION OF THE PENIS.. 573 

in two instances. On one occasion it was found necessai'y to re- 
place the chain twice, and to complete the amputation with the 
knife. 

Reynal has modified the crushing operation by making the 
action of the ecraseur slower. He has invented a small instru- 
ment (ecraseur) which is left in place for two or three days, being 
tightened every day, or several times a day, until the mortification 
is complete, and the diseased penis sloughs off. In this method, 
a metallic catheter is placed in the urethra ; in the other the 
catheter is not required. 

In reflecting upon the various modes of operation we have 
thus described, and noting especially the two very important, and 
indeed, essential requirements referred to by Zundel, in respect to 
the matters of micturition and hemorrhage, we are struck with 
the fact that in none of those methods are these obvious require- 
ments complied with, or if they are, it is in a manner so faintly 
imphed, and so indefinite and unsatisfactory as to be scarcely 
intelligible, and certainly to leave no distinct impression on the 
mind, of the importance of the points referred to. 

In every case the danger of possible subsequent interference with 
micturition is threatened, whether the catheter is used during or 
after the operation, or even, we fear, if left in the passage " at least 
two months," as recommended by Peuch and Toussaint. We can 
remember cases of our own which, with even a longer retention 
of the catheter, were followed by failure. We have attempted the 
formation of an artificial urethral opening below the ischial arch, 
and with no better result. 

We are tempted to believe that the hemorrhage is less danger- 
ous than many think, and we believe it could be controlled by 
ordinary pressure, or by plugging the sheath afterward, or by 
still other means of hemostasia. 

Taking all this into consideration, we cannot but think strange 
of it, that the process used in human surgery, which we find 
merely mentioned in some European woi'ks, but which we believe 
has been performed by Gerlach, and which we ourselves adopted 
more than fifteen years ago, should be practically ignored or 
rejected by writers as well as practitioners. We have practiced it 
during the period mentioned without having encountered the 
slightest comphcation or troublesome sequelse. 

We refer to it as the only safe, and as, therefore, the best mode 



574 OPERATIONS ON THE GENITO-URINARY APPARATUS. 

of operation for the amputation of the penis. It differs from any 
that have been previously recommended, and is as follows : 

The animal being prepared for the operation in the ordinary 
way, the penis is secured with a ligature at its end and drawn 
out of the sheath, and another ligature tightly applied on the 
upj)er part of the organ. An incision of the skin covering the 
penis is made entirely around the organ and down to the cavern- 
ous body, with the precaution of drawing the skin slightly back- 
ward, so that when the amputation is completed, and the skin 
allowed to return to its position, it will sHghtly overlap the stump 
of the penis. 

We divide the cavernous body, carefully avoiding injury to the 
urethra, and when this organ is reached it is dissected from 
its groove forward into the cavernous body (Figure 477a) for a 




Fig. 477a. —Amputated Penis, with the Urethra Protruding. 

length extending between one and one-half to two inches, when 
the division across the urethral canal completes the amputation. 
The removal of the diseased tissue being thus made, we have before 
us the stump of the cavernous body, almost dry, the hemorrhage 
being prevented by the upper ligature, which moreover, seciu-es a 
good hold and good view of the mutilated organ. The urethra is 
then slit on its inferior border on the median raphe and both flaps 
turned upward and brought in contact by interrupted sutures with 
the skin which has been so divided as to overlap the stump 
(Fig. 4775). These sutures are made close to each other, of strong 
s ilk or catgut. The res'ult is that the stump of the penis carries 
at its lower margin a sht of from one to one and one-half inches 
in length, which, after allowing for all shrinkage of cicatricial 
tissue, will always be sufficient to permit thorough micturition. 



AMPUTATION OF THE PENIS. 



575 




Pig. 4776,— Stump of Amputated Penis, with Stitches uniting Urethra and Skin. 

The sewing done and tlie upper ligature removed, the penis re- 
tracts within the sheath, and the animal is allowed to rise. 

We have been performing this operation for fifteen years, and 
have never yet met with the slightest compHcation or disappoint- 
ment. 

In dogs the amputation of the penis is indicated for about the 
same diseased processes as in the horse. The amputation, however, 
does not include only the soft tissues, but also the bone of the penis, 
which is divided with nippers or a saw. The division of the cav- 
ernous body is done with the ligature or the ecraseur. Strictures 
of the urethra are of common occurrence after this operation, and 
can be overcome only by the repeated introduction of the catheter, 
or the enlargement of the urethral opening with the knife. 



CHAPTEK Xni. 
OPERATIONS ON THE FOOT. 

ANATOMY. 

In our domestic animals we call the foot the extremity of the 
leg, and even only the extremity of the digit, for, considered in a 
zoological point of view, the foot extends from the carpus or tar- 
sus to the last phalanx, inclusive. 

The foot of the horse forms an extremely important study on 
account of the numerous diseases to which that member is sub- 
ject, and also of the value of the motor powers required from the 
horse ; the old horsemen expressed this importance by the aphor- 
ism, "no foot, no horse." This truth finds daily its sad applications 
in the prematiire ruin of large numbers of horses rendered useless 
because of the defects in their feet. All the quahties of a horse 
are, indeed, considerably diminished and can even be entirely 
destroyed, by the bad conformation or accidental alterations of 
these essential organs. The study of the foot of the horse has 
been the object of many voluminous works, such as those of Gir- 
ard, Bouley, Bracy, Clark, Anker, Leisering & Hartman, Lafosse, 
Gourdon, Reynal, Defays, and many others, to which we refer for 
the more complete description of the organization of the foot. 

The organ is composed of two orders of parts, some internal, 
organized and sensitive ; the other external, formed of a horny, 
organic substance, the hoof, but entirely void of the property of 
^atal sensitiveness. The internal parts are bones, three in number, 
the second and third phalanges, and the small sesamoid, which 
form by their reunion the articulation of the foot ; special liga- 
ments, which maintain the connections of these bones ; tendons, 
which fill the triple office of agents of transmission of motion, 
articular ligaments and organs of support of the weight of the 
body; a fibro-cartilaginous apparatus, superadded to the third 
phalanx, and which completes, so to speak, posteriorly, and 
increases the surface by which it rests on the hoof and transmits 



ANATOMY OF THE FOOT. 



577 




Fia. 478.— Longitudinal Section of tlie Digital Region. 

A.— Lower part of the plantar cushion. B.— Ligamentous bands of the fibrous 
layers of the plantar cushion. C— Fibrous membrane of the plantar cushion. D.— In- 
sertion of the plantar cushion to the inferior face of the os pedis. E.— Spongy tissue of 
08 coronse. F. — Articulation of first and second phalanx. H. — Perforatus tendon at- 
tached to the OS coronae. I. —Insertion of plantar aponeurosis to the semi-lunar crest. 
K.— Spongy structure of os'suffraginis. L. — Section of perforatus tendon. M.— Yellow 
fibrous band uniting the anterior face of the perforans tendon to the posterior face of 
the 03 coronsB. N. — Synovial sac of the sesamoido-pedal articular. O. — Tendinous sesa.- 
moid sheath. P. — Synovial capsula of the articulation of- the foot. T. — Perforans ten- 
don. Y.— Metacarpo-phalangeal joint. 

to the ground the pressure which it receives. These are the lat- 
eral cartilages and the plantar cushion ; arteries, veins, lymphatics 
and nerves, remarkable for their number, development and dispo- 
sition; and at last, a ligamentous, sub-horny membrane, or kera- 



578 



OPERATIONS ON THE FOOT. 




Fig. 479.— Plantar Nerves in Digital Region. 

P.— Plantar nerve. A.— Origin of the digital nerves. BB.— Cartilaginous branch. 
C C— Cutaneous branch. D —Digital artery. G.— Transverse branches back of the fet- 
lock joint. I. — Nerve of the plantar cushion. L. — Lateral band of the plantar cushion. 
v.— Digital vein. 

togenous apparatus, forming a continuation of the skin, whicli 
surrounds the parts of the foot like a stocking, and upon which 
the foot rests, as a shoe on the human foot. In this ajsparatus are 
found : 1st, the coronary band, which forms a rounded projection 
at the separation of the skin and hoof, and which serves as a 
matrix to the periople and the wall ; at its surface are seen numer- 
ous villosities or papillae ; 2d, the podophyllous or laminated tissue 
which is spread upon the anterior face of the third phalanx, and 
is remarkable by the sheet of jjarallel laminge which it presents at 
its svirface, separated by deep furrows in which are received the 
analogous laminae of the internal face of the wall (Figure 481) ; 



ANATOMY OF THE FOOT. 



579 




Fig. 480.— Arteries of the Digital Region. 
AAA.— Digital artery. B.— Transversal branch in front of fetlock joint C— Per- 
pendicular artery of Percival. D.— Its ascending branch. E.— The descending branch. 
F.— Branch to form the superficial coronary circle. G.— Posterior transverse branches. 
K.— Artery of the plantar cushion. P.— Circumflex artery, C C— Ascending terminal 
branches of the digital artery. 

3d, the velvety tissue or villous tunic which covers the plantar 
cushion at the interior face of the foot, and is the secreting organ 
of the sole and frog, its surface covered with villosities similar to 
those of the coronary band, and like them, of various sizes, are 
lodged in the porosities of the internal face of the sole and frog. 
The external parts of the foot are four in number : the wall. 



580 



OPEBATIONS ON THE FOOT. 




I /„ I 

Fig. 481.— Portion of the Keratogenous Apparatus. 
A.— The skiu. B B.— Coronary band. R.— Its villosities. P.— Podopbyllous tissue. 




6f 7 

Fig. 482.— Section of the Hoof. 
l._Periople. 2.— Cutigeral cavity. 3.— Keraphillous tissue. 4.— Wall. 5.— Contin- 
uation of the periople with the frog. 6.— The sole. 7.— Union of the sole and wall. 
&— Frog stay. 

the sole, the frog and the periople (Fig. 482). These form, 
together, a horny box, the nail, or hoof, which is adapted exactly 
by its internal cavity to the external contour of the sub-horny 
membrane, contracting with it an intimate union by a reciprocal 
reception, and thus completing the structure of the foot, furnish- 
ing to the sensitive parts an apparatus, thick, hard, resisting and at 
the same time elastic, which makes one with them, and protects 
them against violence from the substances with which the foot, 
from the nature of its function, must necessarily come in contact. 



ANATOMY OF THE FOOT. 581 

The homy substance which constitutes the hoof has a fibrous 
aspect ; it is hollowed all over by cylindrical canals, whose superior 
extremities, widened into a funnel shape, cover the papUlse of the 
matrix of the hoof, either at the coronary band or velvety tissue, 
while the inferior open in the wall upon the plantar border, in the 
sole and frog, at the external or inferior face. These canals are 
rectilinear, except those of the frog, which are flexuous ; their 
diameter varies from 0, 02 to 0, 2 or O^"-"- These tubes are not 
only hollowed in the horny substance ; they have also proper waUs, 
of very great thickness, formed of numerous concentrical layers, 
received into each other. These are lamellae of pavimentous 
epithelium, which constitute the horny tissue ; in the walls of the 
horny tubes, they are grouped flatwise around theii* inferior canals, 
and stratified from within outward, so as to form successive and 
concentrical layers; in the intertubular horn, these lamellae are 
not stratified in a direction parallel to that of the tubes, but at 
right angles with it. Ai'ound the tubes, the lamellae have an 
oblique intermediate dii'ection. A granular opaque substance fills 
up the space lying between the horny tubes and the papillae. 

The hoof, which is a part of the epidermis, develops similarly, 
that is, by the constant formation of cells in the layer which cor- 
responds to the mucous malpighian body, at the expense of the 
plasma thrown off by the numerous blood-vessels of the keratoge- 
nous membrane. The velvety tissue is the starting point of the 
elements of the sole and frog ; the periophc band is the organ 
secreting the periople ; and the coronary band proper, the matrix 
of the wall. Upon these different parts, the epithehal ceUs multi- 
ply and flatten into lamellae, in the direction of the surface of the 
keratogenous membrane, as they spread from it. The wall then 
grows from its superior to the inferior border, and the other parts 
of the wall from their internal to their external face. The villosi- 
ties of the coronaiy band and of the velvety tissue are the organs 
around which accumulate the epithelial cells ; their presence 
defines, consequently, the tubular structure of the horn. 

The laminae, in the physiological state, do not co-operate in a 
sensible manner with the formation of the wall ; the keraphyllous 
laminae form themselves at the coronary band, at the origin of the 
podophyUous ; they descend with the wall, gUding at the surface 
of the layer of cells which separates them from the laminated 
tissue, a movement of descent which is f acihtated, however, by the 



582 OPERATIONS ON THE FOOT. 

mviltiplication in the same direction of the said cells. When the 
podophyllous tissue is inflamed, whether exposed or not, its latent 
activity soon manifests itself. It gives rise to a great quantity of 
hard horn, hollowed, as seen by Gourdon, with tubes, and oblique 
in a direction backward. These tubes, more irregular than those 
of the normal wall, are disposed in a parallel series ; they are in 
form round, villo-papillae, which have developed on the face border 
of the laminae. In these cases of production of horn by the action 
of the podophyllous tissue alone, one never sees, between the 
sensitive laminse, distinctly formed horny laminae in the middle of 
the other cells, as it is observed in the wall proceeding from the 
coronary band. The horn which rises on the surface of the 
podophyllous, immediately after the removal of the piece of the 
wall, is not a permanent one ; it must be replaced by the horn 
of the coronary band. -This change is complete, microscopical 
examination proving that the wall which descends from the 
coronary band, provided with keraphyllous laminae, engages itself 
under the temporary wall, and slides by the action already 
described over the surface of the soft cells of the laminated tissue. 
As soon as this tissue, modified by inflammation, is covered over 
by the permanent wall, its papillae become atrophied, and its action 
returns to the limited boundaries of physiological condition. — 
{Chauveau.) 

The foot is an organ of support and an apparatus of elasticity; 
it is through it that the whole animal machine maintains its rela- 
tions with the ground, and that it adapts itself in its various move- 
ments, so to speak, to its roughness. It is this that, as a last 
spring, distributes and modifies the force of aU the movements of 
the horny mass of the body, whose columns, the legs, may be 
considered as the resultant. Intermediate with the body and the 
ground, the foot transmits aU the actions of weight reaching it, 
and also between the. body and the sensorium, toward which all 
sensations resulting from its contact with surroimding external 
substance return, the foot then becoming at the same time an organ 
of feeling. To adapt it to this triple formation, nature has given 
to it three properties, in appearance incompatible with each other, 
which has, however, harmonized, viz.: first, a very great external 
hardness, due to its horny envelope ; second, a certain amount of 
flexibility, the combined result of the physical properties of its 
cortical envelope and of its mechanical disposition of its different 



ANATOMY OF THE FOOT. 



583 



parts, and thirdly, a highly developed sensibility resulting from 
the high organization of its tegumentary membrane. — Bouley. 

DISEASES AND DEFECTUOSITIES OF THE FOOT IN SOLIPEDS. 

Of all the domestic quadrupeds, the horse is the most exposed 
to diseases of the foot, which are more or less frequent in him 
according to the work he is subjected to, the places he Hves in, 
and the nature of the ground upon which he travels. As rare as 
are those accidents in farm horses, so common are they among 
horses in cities, of heavy draught, and also army horses ; in aU, in 
fact which travel continually on hard, paved and stony roads, and 
especially in large cities, where all those injuries can but be the 
result of their constant work on stone pavements, always so rough 
and sHppery. If to these conditions are added the very numerous 
accidents resulting from bad shoeing, so badly carried on, one will 
be less surprised to see the foot becoming deformed and altered 
in different ways, deteriorated, and preserving with difficulty, and 
for a short time, its state of integrity, and becoming the seat of 
numerous affections. 

We shall distinguish the diseases proper and the vices of 
conformation of the foot. The former are generally sufficiently 
serious to merit special description. Among them some are su- 
perficial, as the false quarters, uncomplicated cracks, or solution 
of continuity, thrushes, canker; others of deeper interest, specially 
those of the keratogenous apparatus, such as laminitis, with its 
complications and sequelae, keraphylocele, seedy toe, and separation 
of the wall, which may extend as far as entii'e sloughing of the 
hoof ; accidents then due to the suppuration accomj)anying several 
diseases of the foot. Some maladies are specially the effects of 
wounds, of contusions such as overreaching, quittor, bruised sole, 
bruised heels, corns, pxmctured v)0U7ids; others are results of 
shoeing, pricked, tight shoe, burned sole; others are deep alto- 
gether, such as bionions, navicidar disease, and, lastly, fracture of 
the OS pedis, or of the navicular bone. 

VICES OF CONFORMATION. 

Among the vices of conformation some are serious, as contrac- 
tion of the heels, flat foot, pumiced foot, club foot, crooked foot, 
rammy foot, and, lastly, the foot xoith bad horn. 



584 OPERATIONS ON THE FOOT. 

(a) Flat foot (Germ. Platfuss). — By this is understood the 
foot in which the sole, instead of having the natural concavity, is, 
on the contrary, flat, and by its whole svirface about on a level 
with the border of the wall and the base of the frog ; ordinarily 
this is accompanied with low heels, more or less contraction, and 
a well-marked oblique direction of the wall. 

Flat foot is generally observed only on front feet, and is very 
common in lymphatic animals or of low breed, raised in low and 
damp soils ; it may be congenital. Large feet, badly shod or used 
up by very heavy work, are predisposed to it. It is claimed 
that the weakening of the sole by too repeated and deep paring 
of the sole wiU ultimately bring it on ; it is said that abuse of 
poultices may produce it ; it follows excess of the hollowing of the 
shoe by the upj)er surface, which, pushing the wall outward, 
obliges the sole to drop lower than its normal level. 

The horse with flat foot rests on all parts of the sole at once ; 
there is no elasticity of the arch of the sole, and percussions take 
place on it entirely. The actions of the animal are heavy, espe- 
cially as it is commonly seen when the feet are large. When the 
foot is somewhat tender, the animal lames easily, especially if the 
shoeing is bad, or if the animal rests on the sole or is obliged to 
trot on rough or stony roads, which render the percussion very 
painful. There arises some irritation, which keeps on increasing, 
and produces several accidents, such as bruised sole, corns, 
pumiced feet. 

The horse which has flat feet often has weak walls, and as the 
nails of the shoe become loose, this is often cast. 

By shoeing one may remedy this bad condition of the foot. 
For this, the foot must be pared flatways, the sole spared, the wall 
relieved only of what is broken off; the frog must be left alone, 
the heels also ; a shoe somewhat wide in the web, protecting, 
therefore, the sole more than an ordinary shoe does. It will be 
adjusted so as to rest on the border of the wall only, and not on 
the sole ; stOl, care will be taken not to hollow it too much or to 
excess. Sometimes a thick shoe only is necessary, without in- 
creased width. Soles of gutta-percha or felt are also used, as 
we will see when speaking of the pumiced foot. 

(b) Pumiced foot (Germ. Vollfuss). — Thus is called the foot 
whose sole projects beyond the level of the wall, and presents a 
convex surface, extending beyond the plantar border, upon which 



ANATOMY OF THE FOOT. 585 

the horse rests. It is the exaggeration of the flat foot. In the 
pumiced foot the wall has a great obliquity, sometimes even 
assuming a nearly horizontal direction. 

The horse is never born with such feet ; this is a malformation, 
accidental, or resulting from various causes. One of the most 
common is lack of care of the foot, of necessary caution, for 
instance, ia paring, or shoeing in such a way as to bring the rest 
of the foot on the circumference of the under part in such a way 
that the sole does not touch the ground, and ceases to be pressed 
by it. Too much concavity of the shoe may bring on this result, 
by resting only on a too narrow part of the inferior border of the 
foot ; and by opposition, not enough concavity will compress the 
tissues, irritate them, and produce the same alteration. Feet 
become pumiced by laminitis, but this is complicated with seedy 
toe. Never, then, is the foot pumiced ia its whole extent ; its 
deformity stops always at the limit of the inferior border of the 
bars ; beyond them, behind, on each side are seen the excavations 
of the lateral lacunae of the frog, so much deeper that heels are 
higher. The hoof does not preserve its circular shape. It atro- 
phies on the side, and presents at the toe an excess of thickness 
in the wall; the heels assume a greater development. 

This deformity is very serious, and disables the horse easily ; 
rest takes place only upon the sole and frog ; after laminitis, upon 
the sole and heels ; it is always very painful. "Work upon hard 
ground and pavement is next to impossible. After laminitis, one 
sees, during walking, that the foot rests upon the heels, and then 
by a motion from backward to forward. An animal with pum- 
iced feet has a tendency to forge and interfere; the slightest 
bruise of the sole gives rise to serious complications. One often 
observes wounds, suppurations, etc. 

The indications are analogous to those of the flat foot ; the 
sole ought to be spared as well as the frog, the walls only ought 
to be slightly trimmed ; the shoe must be made so as to carry 
the rest upon the border of the wall and protect the sole. A\Tien 
the foot is not pumiced to excess, one must use a broad web shoe, 
sufficiently concave to allow the sole to rest in it ; but it must 
not be too excessive, as then the base of the rest would not be 
very firm. A sheet of gutta-percha, or felt, with tar and oakum, 
may be placed between the shoe and the foot. 

(c) Clubfoot (Germ. Bockhuf). — This is the foot in which the 



586 OPEKATIONS ON THE FOOT. 

wall is straightened more or less perpendicularly, or even obliquely 
backward, so that the superior border of the wall is more forward 
than the inferior. The superior levers participate always in this 
vicious direction, which constantly brings back the rest of the 
foot toward the anterior part of the wall, and, according to its 
degree, makes the animal walk more or less on the toe, even some- 
time obliging him to rest on the anterior face of the hoof ; the 
heels are raised from the ground, and the fetlock, instead of being 
open forward, seems to be turned backward. This deformity, 
which exists especially in the hind legs, is very common, and is 
even natural in mules, and supposes, with its presence, high heels, 
which throw the rest on the toe, which is always very thick. It 
may also exist with low heels, especially when due to overwork or 
other accidental cause. Horses which, like mules, are club-footed 
only by a peculiar condition of the parts, walk with firmness, and 
even pull better and work better in hilly countries. If they are 
unfit for the saddle, it is because their reactions are hard, and that 
they tire the rider. It is not so with those which are club-footed 
from hard work ; they continually stumble, are subject to knuck- 
ling, to interfering, or even to falling ; and for these reasons do 
they always require a mode of shoeing which would give them the 
missing solidity, and render their walk more steady. This cir- 
cumstance indicates the necessity of sparing the toe, and throwing 
the weight back on the heels, which, however, must not be pared 
off too much. The best shoe for such feet must be short, thin at 
the heels, with a thick toe, slightly raised upward, and prolonged 
beyond the level of the border of the wall ; small heels to the shoe 
are often advantageous, as giving an opportunity for rest and 
relief. The shoe with truncated branches of Lafosse (slipper), 
which is a short shoe, not extending beyond the quarters, and 
leaving the heels free, is sometimes used. This shoe is very thick 
at the toe, and very thin at the heels. It is unnecessary to say 
that club foot is often cured by tenotomy, or by treatment of the 
tendinous retraction. 

(d) Crooked foot. — ^We call by this name the foot whose sides 
are not of the same height ; it may be crooked outward or inward. 

This deformity may result from a vice of direction of the regions 
above ; ordinarily, however, only from a deviation of the phalan- 
geal one. Sometimes it is due to bad shoeing, to bad paring of 
the feet ; sometimes it follows unequal wearing of the foot, it being 



ANATOMY OF THE FOOT. 587 

without shoe. Colts which have never been shod, and are walking 
for a long time on hard and rough ground, often present this con- 
dition. 

The horse with crooked feet inward, specially if the deviation 
is much marked at the toe, is exposed to cut himself with the 
internal heel of the shoe — to bruise himself ; the horse with crooked 
feet outward cuts himself with the inner toe. Besides these, 
lameness, from lacerations of articular ligaments, may often follow. 

This is relieved, especially in young animals, by lowering the 
side of the wall which is the highest, and sparing the other ; the 
proper shoe for this condition must be thicker in the branch cor- 
responding to the lower side of the foot. The shoe ought to be 
changed quite often, in proportion to the existing difference in 
the height. If the foot is very crooked, it is difficult to straighten 
it by having a greater thickness of the shoe ; it would make this 
too heavy. Sometimes it is better to use nails with large-sized 
heads on the lower side of the hoof ; and in these cases one might 
put on corks at the heels, external or internal, as required. 

(e) Mammy foot. — This is a defectuosity of the foot, always 
accidental, in which the surface of the waU offers more or less 
numerous circles, above each other and running from one quarter 
or heel to that of the other side. These roughnesses, arrranged 
in rows, rise always from the coronary band, and form as many 
elevations gradually descending and disappearing toward the in- 
ferior border of the wall. They are so much more serious that 
they are deep, and sometimes are accompanied with lameness, 
especially when in great number, close to each othei-, and when 
the foot is narrow and long. These circles are sometimes seque- 
lae of laminitis, and accompany seedy toe ; the rings are then in 
the middle of the toe, which is more or less roughened, Hke an oyster 
shell, and they disappear only when the primitive alteration is 
removed. When they are smaU, not numerous, and grow down 
without being replaced by new ones, this favorable disposition of 
the wall must by stimulated by all the means which may stimulate 
and keep up the suppleness, by light bUsters over the coronet. A 
light shoeing, often changed, is the best in those cases. Circles 
which reappear continually are due to an intimate and continued 
alteration, and are in company with other defectuosities, such as 
contraction, pumiced foot, etc. 

(/■) Foot with bad hoof. — A hoof may be too soft or too dry. 



.'v88 OPERATIONS ON THE FOOT, 

When too soft, too greasy, it contains too much dampness and is 
lacking resistance. Horses which have this weak hoof, as said 
Laf osse, have the foot tender and unfit for long walks on hard and 
stony ground ; they are, besides, much exposed to lose their shoes, 
because the hoof breaks up at the nail-holes. This fault is quite 
common in large feet, frequently seen in Northern lymphatic ani- 
mals, especially in those which come from marshy districts ; if, then, 
those horses are submitted to stabulation, their hoof becomes dry 
to excess, which gives rise to narrow and contracted feet. The 
lower part of the foot must be pared with care, as it has but little 
thickness ; the appHcation of the warm shoe while fitting must be 
as short as possible. An ordinary thin and light shoe must be 
used ; the nails will be as Hght and thin as possible, and ham- 
mered in carefully. 

Too dry hoof is liable to break, because it has lost its physio- 
logical suj)pleness ; this brittleness is often met ia animals whose 
feet have been much in water and afterward are placed on dry 
ground ; it seems as if the water had dissolved the adhesion of the 
horny cells. The same condition follows the excessive use of 
poultices and also of strong grease in shape of ointments. It is 
wise to grease, but previously the old crust must be removed. 
Hoof ointments of wax, turpentine or tar are better. The foot is 
called derohe (broken) when by the use of a thick nail it is more 
or less broken at the edges of the wall. These feet lose the shoe 
easily ; animals then go on bare feet, and then it becoraes very 
difiicult to put other shoes on. It is necessary in these cases to 
punch nail holes on the shoe corresponding with parts where the 
hoof is sound. In paring, all the pieces of broken horn are 
removed, or at least as much as can safely be done. Nails are 
secured as high as possible ; shoes must be changed as often as 
possible, and the hoof is to be kept supple by unctuous applica- 
tions. When the breaks of the horn are too large, softened gutta- 
percha, or a mixture of gutta-percha three parts, with one of gum 
ammoniac, melted together, can be used to fill the anfractuosities, 
all grease having been first removed by a wash with ether ; the 
putty hardens, and the shoe can be tacked on solidly. Nails can 
even be punched through the gutta-percha. 



ANATOMY OF THE FOOT. 



589 



Instruments. 

The surgery of the foot requires siDecial instruments for the 
operations which influence aetion upon the hoof, as also for those 
which are to be performed upon the tissues of the foot proper. 

Besides those which are commonly required in ordinary sur- 
gery, such as curved scissors, probes, bistom'ies and forceps, 
others are needed of special forms and for special purposes; 
among those most commonly used are the different sage knives 
and drawing knives. 

Sage knives are lanceolated blades secured to handles, and 
are either double or right or left. The blade, which is curved 
upon its long axis, may be sharp on both edges, as in the double, 



Fig. 485. 



Fui. 484. 
SAGE KNIVES. 



Fig. 483. 



(Fig. 483) or on only one or other edge, when it is known as a 
right (Fig. 484) or left (Fig. 485) sage knife, being thus adapted 
to use by either the right or the left hand. 

Drawing knives, which are made somewhat like those used by 
blacksmiths in the ordinary method of paiing the foot, yet differ 
from those in being straighter in their attachment 'to the handle, 
and also on being curved on their long axis, being also sharp on 
both edges. The groove of the instrument is made to vary in 



590 



OPERATIONS ON THE FOOT. 



width, and thus can be used as the different steps of the operation 
may require (Fig. 486). Sometimes the drawing knife resembles 
more that of the blacksmith, as being sharp on one edge only (Fig. 
487), and in this case the groove of tTie blade is generally much 
narrower than in the others. Some special operations require 
peculiar forms of drawing knives ; for instance, those which are 




Pig. 487. 



Figs. 486. 
DRAWING KNIVES. 



Fig. 488. 



made with a blade perfectly straight and narrow, very slightly 
sharp on the edges, but having a very narrow groove at the ex- 
tremity (Fig. 488). These are used principally in the scraping of 
diseased bone-structure, in deep punctured wounds of the foot, 
and in cartilaginous quittor, when small sections of cartilage are 
to be removed from the lateral border of the os pedis, which could 
not othewise be accomplished. 

Other instruments are also required, the description of which 
will be given as we refer to the different diseases where they find 
their applications. 

Genekal Operations. 

Removal of the sole (Germ. Absohlen). — This is an operation 
by which the sole of the foot is removed by severing it from the 
living tissues underneath. In times gone by this operation was 
extensively performed, being considered indispensable as soon as 
the slightest lesion under the sole existed. It was alleged that 



ANATOMY OF THE FOOT. 591 

vmless this was done the suppuration would be likely to spread 
underneath the horn. In our days it is rarely performed, as it is 
considered that it presents but Uttle advantage, so far, at least, as 
it involves the removal of the entii-e organ. Sometimes, however, 
poi-tions of it have to be taken off, as in some special diseased con- 
dition of the foot, such as in punctiu-ed woimd, pricking by the 
blacksmith, burnt sole, etc., the modus operandi of which will be 
considered when treating of these diseases. 

Itemoval of portion of the locdl. — A few morbid conditions of 
some parts of the foot require ia their treatment the removal of a 
portion of the wall, in order that the escape of pus, the removal 
of diseased tissue, or the sloughing of necrossed cartiliginous or 
bony structure, as in complicated cases of suppurative corns, of 
quarter-crack or in cartilaginous quittor. A similar operation is 
sometimes requu-ed in cases of toe-crack, complicated with disease 
of the OS pedis. 

These will be further considered when treating of these special 
subjects. 

Dressings. 

As nearly every operation of the foot requires a mode of dress- 
ing pecuhar to the manipulations which have been necessary, we 
shall, when speaking of the different diseases, where parts of the 
walls have been removed, iuclude also a description of the peculiar 
dressing they require. 

There is one, however, which is thought much of in veterinary 
surgery, and of which we will have to say more when speaking of 
punctui-ed wounds of the foot. This is the dressing with plates, 
which serve to retain the plantar surface, the balls and pads of 
oakum, which are placed to protect the wound. The application 
of these plates is far superior to the leather sole, because of its 
easy removal when the parts are being examined, and of their easy 
replacement ; thus allowing the surgeon to change the dressing 
whenever he sees fit, without being obliged to remove the shoe. 

DISEASES. 

Canker of the Foot. 

(Germ., Strahlkrebs, Hufkrebs). — Under this somewhat un- 
scientific,* though accepted name, is designated a pecuhar disease 



* Crwpaud of the French. 



592 OPERATIONS ON THE FOOT. 

of the feet of solipeds, seated in the secreting tissues of the horny 
box, always beginning at the frog, and characterized by alteration 
of the homy secretion. Names of a more scientific meaning have 
frequently been proposed, such as gnaioing ulcer (Bourgelat), 
schirrus or cancerous carcinoma of the frog, carcinoma of the 
reticular tissue of the foot (Vatel), darter of the plantar cushion, 
chronic podoparenchydermitis (Mercier), and epithelioma of the 
frog (Fuchs). None of these has ever been accepted, and the old 
hippiatric name has been retained. 

History. — It is conceded that the old veterinarians were ac- 
quainted with canker, and Vegetius evidently speaks of it, but not 
until the time of Solleysel do we find a description somewhat 
complete of the disease and its treatment ; Garsault, La Gueri- 
niere, Weyrother and others spoke of it, and have expressed 
various opinions as to its etiology, and especially as to its treat- 
ment. So little progress was discernible in the writings of Bour- 
gelat, Chabert, Huzard and Girard, on that very question, and so 
many false ideas were admitted, that Chabert in despair has called 
canker the opprobrium of veterinary medicine. 

It is but recently that serious research as to the nature of 
the disease have thrown some hght on the question, and estab- 
lished the important fact that its seat is not in the disorganized 
horn, but in the secreting organs, and that there is an alteration 
in the products of this secretion ; that it is consequently to these 
that remedies must be applied. 

We might refer to the writings of Jeannie, Crepin, Hurtrel 
d'Arboval, Prevost, Mercier, Plasse, Percivall, Dietrichs, Eichbaum, 
Wells, H. Bouley, Reynal, Haubner, Fuchs, Rey, Megnin, etc., 
each of whom has furnished his contingent, while stiU. the inti- 
mate nature of the disease remains but imperfectly known, and 
there is but little certainty either in the treatment or its results. 

Let us observe, however, that in our day canker has become 
comparatively a rare disease, especially in cities, which, doubtless, 
is because of the cleanliness of the streets. In the beginning of 
this century, canker and grease — closely related diseases — were 
frequent in Paris; then horses were obliged to travel through 
deep gutters of mud, while to-day these affections are exceptional 
occurrences (H. Bouley). The same thing has been observed by 
Percival in England. "When hygienic precautions were not as 
well understood as they are to-day, in establishments employ- 



DISEASES. 593 

ing large numbers of horses, when the stables of mail and stage 
coaches, and even those of mihtaiy garrisons, were small, ill- venti- 
lated and dirty, among horses standing in filth and soiled manure, 
these affections were relatively common ; with hygienic improve- 
ments, they have almost disappeared. In the army, canker was 
the cause of considerable annual loss, almost as serious as those 
from glanders ; to-day it is rare and almost unknown. 

Improvements in the different breeds of horses, either by bet- 
ter choice of reproducers, or by changes in the mode of feeding, 
resulting from the progress of agricultural processes, the suppres- 
sion of common pastures, etc , have contributed to render the 
disease less common. 

Symptoms. — It is seldom that the symptoms of canker can be 
observed from the start ; slow in its progress, and not surexciting 
the sensibihty of the parts, the disease may progress without 
manifesting any ill effects, and consequently escape notice by the 
owner or groom, nothing appearing to call his attention to the 
affected foot. Thus, in a majority of cases canker is only dis- 
covered after it has been in existence for a considerable period, 
and when serious alterations have already taken place. It is 
often at the shoeing shop, when the shoes are changed, that in 
the laminae is observed a moistiu*e more or less abundant, giving 
rise to softening and raising of the hoof. The disease sometimes 
attacks only one foot, often several feet at a time ; at times when 
one foot is cured, another becomes affected, and the disease thus 
appears traveling alternately from one foot to another. 

Usually the disease begins with the inflamation of the kerato- 
genous membrane which covers the median lacunae of the plantar 
cushion ; the hoof covering this is softened, raised by a serous 
moisture, and once loose, is not renewed, the tissue producing it 
ha\Tag lost its function of secreting the horny substance, and now 
secreting a serous element, which becomes the caseous matter of 
which we shall speak hereafter. 

Sometimes the disease begins by moisture in the hollow of the 
coronet, by a kind of grease, a disease which we shall see to be of 
the same nature as canker. The is an cedematous swelling, warm, 
somewhat painfvd, of the phalangeal region, first serous, then be- 
coming opalescent, which seems to filtrate through the softened, 
but not yet raised, epidermis. This inflammation, spreading Httle 
by little toward the hoof, extends to the plantar keratogenous 



594 OPEKATIONS ON THE FOOT. 

membrane, and gives rise to an exhalation of the same nature as 
that of the skin which produces the separation of the hoof, and 
the first marks of canker. 

Sometimes one may observe at once, a fungoid growth of ficus, 
formed by an hypertrophy of the tissues underneath ; this growth 
is more or less moist and offensive, bleeding easily, having the 
aspect of caidiflowers, and protruding through a break of the 
softened hoof, and forming a thready detritus to be subsequently 
studied. Commonly, the hoof is more or less loose, and under it 
is a caseous matter, greasy, ordinarily of a foetid odor, easily re- 
moved by scraping, being non-adherent to the tissue which 
secretes it. If the parts are well cleaned from this, the velvety 
tissue of the pyramidal body of the frog, appears to be covered 
with a smooth membrane of a slight whitish color ; the external 
layer then appears formed by a pellucid epidermic covering, show- 
ing through its transparency the purplish color of the capillaries 
underneath. The velvety tissue is diseased, but still retains its 
functions, which, on the contrary, are increased but perverted, 
and instead of secreting a horny substance which adheres to the 
surface of tbe keratogenous membrane, produces the caseous mat- 
ter already referred to. The break in the hoof frequently seems 
small in size. Nevertheless, the alteration of the keratogenous 
tissues, viz : the substitution for its normal, of a pathological se- 
cretion, whose product is this loose caseous matter, is far ad- 
vanced. There is then an extensive, though a concealed separa- 
tion of the hoof. One then must not allow himself to be deceived 
into supposing it to be a limited diseased process, by the apparent 
external integrity of the horny box. 

The characteristic of canker is its tendency to spread, like can- 
cerous affections. Once manifested in any part of the sub-horny 
tissues, the special changes which characterize the disease seldom 
remain circumscribed; on the contrary, they generally extend 
from that part as a centre, throughout the whole circumference, 
and little by little, attack slowly but continuously the whole ex- 
tent of the secreting apparatus, and thus loosen the entire horny 
box — starting from the median lacunae, or the glomes of the frog, 
it extends to the branches and the body of the plantar cushion ; 
then spreads at the side, in the lateral laminae, from there all round 
on the velvety tissue, then by degrees reaches the inferior ex- 
tremity of the podophyllous laminae and going upward, reaches 



DISEASES. 595 

the coronary band, the last point, where, in extreme cases, the 
hoof preserves its adhesions with the tissues which form it. In 
this condition the disease process progresses more slowly than be- 
tween the sole and the velvety tissue, and then it seems to remain 
stationary ; otherwise the dropping of the hoof would be possible. 
We have seen that often at the beginning, but especially as the 
disease progresses, there are growths called fici, found principally 
round the laminse, the frog and the sole. These are of whitish 
color, opal, varying in size and in shape ; they constitute an 
irregular mass, formed of those fici pressed together ; some of 
these growths have a wide basis, others are somewhat peduncu- 
lated ; sometimes they are single, tubercular, slightly elevated ; at 
other times elongated bodies, true fibrous bundles. The fici are 
nothing more than the normal villosities of the keratogenous tissue 
which have become tumefied and hj^^ertrophied, and are found 
principally where, in the normal state, the villosities of the velvety 
tissue are themselves more numerous and more developed. Where 
these vegetations are confluent, as upon the sharp edge of the 
bone, they are separated from each other by a kind of deep sinu- 
ous grooves, filled with the caseous matter secreted by the diseased 
keratogenous structui-e. These growths bleed easily and grow 
rapidly again when excised. Those most developed, and which 
seemed to form a homogeneous mass, constitute, however, an 
aggregate of smaller vegetations united in a certain part of their 
extent, and continued at their bases. 

Besides the vegetation of the living tissues, the plantar sur- 
face of the foot presents, in old cankers, isolated fasciculi of solid 
homy substance, of thready appearance, soft, analogous in their 
form to coarse brushes whose hairs are glued together. These 
isolated, still adherent, brushes are seen spreading toward the 
sole ; they correspond with parts of the velvety tissue which have 
maintained their soundness in the midst of the diseased surface, 
and there continue to secrete healthy hoof. These homy growths 
are ordinarily multiple, and are of various shapes, often twisted, 
and give to the plantar surface a pecuHar aspect, so much so, that 
their brushy masses sometimes retain the mud of the streets and 
are filled at their bases with a black and foetid substance of an 
ugly appearance. 

When canker has arrived at a very advanced period, it is char- 
acterized by the deformity of the whole horny box, whose length 



596 OPERATIONS ON THE FOOT. 

and width is considerably increased. The last of these conditions 
is a sure sign that the disease has spread under the wall of the 
quarters and of the heels, and has produced the complete separa- 
tion of the bars from above and below, "When percussed, the 
hoof at the heels gives a dull sound. The excessive length is only 
an indirect consequence of the disease, and is due to the fact 
that, so as to keep the animal at work, the walls are spared as 
much as possible by the blacksmith, so as to avoid the contact of 
the protruding parts with the ground. 

Physiological signs are almost entirely absent in canker. It 
is a curious fact that the sensibihty which is generally highly in- 
creased in all affections of the foot, even in chronic diseases, re- 
mains always so obscure in canker that animals may be used for 
a long time without lameness, though the sub-homy tissues have 
become quite unprotected over a large surface. 

Complications. — Yery frequently, canker is complicated by a 
disease of the skin, analogous to it, known as grease ; a disease 
which, if not entirely of the same nature, as admitted by Plasse, 
Megnin, etc., is closely related to it. It is often through this 
that canker begins, and very often the two diseases exist together 
in the same animal, one sometimes following the other, just as 
canker of one foot follows that of another. 

Among the complications of canker, as generally admitted, are 
some injuries of the plantar cushion : inflammation and necrosis 
of cartneges, ligaments or tendons, and even caries of the os pedis 
and anchylosis, which are sometimes observed ; however, a close 
examination of the facts allows us to say that these accidents do 
not arise under the simple influence of the disease alone, but that 
they are due to the improper use of sharp instruments, of the 
actual cautery, and especially of potential caustics. As La Gueri- 
niere said, the deep lesions of tendons and of the os pedis, which 
are observed in severe cankers, have no other cause than the 
action of too powerful dessicatives. 

Duration, march, termination. — Canker is an essentially chronic 
disease, and may be of long continuance, even lasting for years. 
Still, under this heading there are many variations, whose cause 
it is difficult to find. There are horses whose disorganization of 
the hoof is complete after two or three months. There are others 
where the disease remains stationary for more than a year. We 
have seen it remaining limited to one lacuna for months, and all 



DISEASES. 597 

at once assume a rapid evolution of disorganization. "We have 
noticed this principally after the use of sharp instruments. 

Generally, animals affected with canker feed well, and for a 
long time retain a good condition ; toward the end, however, they 
lose flesh and exhibit symptoms of septicohemia, especially if 
affected with grease. We do not admit that, as advanced by 
some, canker can give rise to such virulent diseases as glanders 
and farcy. 

Diagnosis. — At the beginning, canker may be confoiinded 
with thrushes, and many veterinarians have considered this as the 
first stage of canker. There is, however, a great difference be- 
tween the two : first, as to the anatomo-pathological point of 
view, inasmuch as the pultaceous, foetid secretion is less abund- 
ant ; that the loosening of the hoof is less, and that there are no 
fici; and again, especially in the point of view of the treatment, 
where single cases of cleansing, with or without dessicatives, 
easily control it, while canker remains rebellious to them. 

Prognosis. — The prognosis varies. Where the animal is 
young, well fed, and the disease is not too old, it is favorable. 
Yet it remains uncertain, as often the most benign form may last 
long and remain rebellious to all treatment. The severity and the 
extent of the internal lesions cannot be estimated by the altera- 
tions or deformities of the hoof, as these appearances are often 
decejDtive. Canker, though considered incurable for a long time, 
is not absolutely so — far from it ; with rational treatment, projD- 
erly carried on, it is curable in the majority of cases. There are 
cases, however, not very rare, where relapses and useless attempts 
have discouraged the owner as well as the veterinarian, and where 
it has been more advantageous to destroy the animal rather than 
to submit him to a long, tiresome, and always expensive treat- 
ment. 

Pathological Anatomy and Nature of the Disease. — It has 
always been considered that a morbid condition susceptible of 
producing disorders so severe as those produced by canker, must 
necessarily be a deep affection, essential and important to the 
organic structure, and depending on a complete transformation in 
its textm-e. And, indeed, it is the impression which predominated 
from the time of Solleysel down to the foundation of veterinary 
schools and which still exists with Girard, who considers canker 
as a gnawing ulcer which changes and alters the tissues it invades. 



598 OPEKATIONS ON THE FOOT. 

and even witli Vatel and Hurtrel d'Arboval, who looks upon canker 
as the carcinoma of the reticular structure of the foot. 

It is but recently that these ideas have been abandoned. Du- 
puy, in 1827, considered canker as a hypertrophy of the fibres of 
the hoof, admitting at the same time the disintegrations and 
softening of those same fibres occasioned by an ammoniacal sap- 
onization produced by an altered secretion. 

In 1841, Mercier expressed the opinion that canker is nothing 
more than a chronic inflammation of the reticular tissue of the 
foot, characterized by diseased secretions of this apparatus. 

It is now known that there is in canker no essential alterations 
of the sub-horny tissues ; no radical change of their substance, 
and no deposit of heteromorphous molecules in their structure. 
This last mentioned fact was well observed by Robin, who in his 
microscopical remarks constantly observed the absence of the 
characterizing elements of canker. Hertwig and Haubner, who 
have made researches in the same direction, arrived at the same 
result and have noticed the absence of any cancerous cells in 
canker. This opinion is, however, doubted by Glisberg and Fuchs, 
who look upon canker as an epithelioma, though they bring no 
sufficient evidence to establish it. 

Except vegetal parasitism, of which we will speak hereafter, 
and which makes of canker a true dartre, an herpetic disease, as 
demonstrated by Megnin, there is only in canker a chronic in- 
flammatory condition of the sub-horny tissues which is mani- 
fested by a perversion in theu' secretion, and is complicated by 
a morbid hypertroj)hy of the villous processes by which their sur- 
face is normally covered. Robin has seen in the fici, papillae made 
thicker and more brittle by the plastic infiltration which moistens 
them; he has observed besides, that at the points where the secre- 
tion is good, it is so active, that instead of drying in sheaths, to 
scale off afterward in transverse pieces, as normally occurs in the 
frog and sole, the epithelial cells grow lengthwise, as those which 
form the walls of the foot. Hence these long, horned, twisted 
threads (epithelioma?) which are seen rising from the sole of long 
affected cankerous feet. 

It has sometimes been admitted that fici had deep roots in the 
tissues, and even in the plantar aponeurosis, which is an error ; 
injections and macerations having shown that there are no essen- 
tial changes in the anatomical structures of these parts, and that 



DISEASES. 599 

what have been considered as the roots of fici were only cellular 
tissues, which has become indurated under chronic inflammation 
(Bouley). Fici are only fasciculi of villosities whose vascular net- 
work is no longer retained by the thick horny box which encloses 
them and which is infiltrated with plastic material. 

Bouley has already admitted that canker could not be better 
classified than among skin diseases, with and after dartroid afi"ec- 
tions, and thus gave reason to Huzard senior ; Plass also f ovmd 
that canker had the greatest analogy with grease, and that in it 
the nutrition of the horn iinderwent the same alteration with nu- 
trition of hairs in the second affection. 

Megnin, in 1864, observed, in operating upon fresh pieces 
taken from the living animal, and from one which had not received 
any treatment, that in canker there is constantly a cryptogam, as 
in favus, and that canker is a parasitic affection. 

Examining the caseous product of the abnormal secretion which 
charactemes canker, Megnin found in it a large quantity of very 
animated vibrios, swimming in a liquid having in suspension nu- 
merous epidermic cells more or less advanced in dissolution ; he 
found besides rounded corpuscles, which he recognized as the 
spores of the cryptogam, and from which the vibrios escaped at 
the maturity of the granulations there contained. In examining 
the fici, he has recognized them to be an aggregate of hypertrophied 
villosites, at the base of which were found in the mass obtained 
by a slight scraping epidermic cells or parts of cells enclosed in a 
net-work of inter-crossed, ramified threads, appearing to rise from 
certain centers marked by an agglomeration of spores, forming in 
their whole a yellow spot. In the water of the microscopic prep- 
arations, one finds also several of these isolated threads, epithelial 
cells, globules of lymph, of blood and finally spores ; very rarely 
vibrios ; oftener micrococci. These threads are nothing more than 
the parasites, the myceUum product of the vegetation of the 
spores ; those contained in the serosity, swell, break up, and the 
granulations which escape from them become for some time the 
vibrios, or as we prefer to call them, pseudo-vibrios ; as soon as 
the brownian motion, which for some time animates the granula- 
tions, ceases, the cells which have proceeded from them (the micro- 
cooci) gather together in chains and form the characteristic threads 
of the mycehum. 

This parasite of canker has been named by Megnin the kera- 



600 OPEKATIONS ON THE FOOT. 

phyton or parasitic plant of the horn, by analogy with the tricho- 
phyton, the parasite of the hair. We consider this name very 
appropriate and prefer it to the name of odium batracosis, parasite 
of the canker, which Mr. Megnin has also proposed. 

Etiology. — The causes of canker are yet but little known; 
there is one, however, which cannot be ignored, and which, if it 
does not produce the disease, assists materially in its develop- 
ment and is indispensable to its existence. We refer to the con- 
dition of dampness. It is that influence of dampness which 
explains why the disease is so very common in the marshy lands of 
Poitou ; in the pastures of Holland, and in general in low grounds ; 
and why it is more frequent in northern than in southern coun- 
tries. Canker is incomparably more frequent in rainy seasons than 
in those where dryness predominates. We have already seen in 
the history of the disease that it is since the streets and the stables 
of admiaistration are kept more free from dampness that canker 
has become less common. 

Sometimes the action of direct irritating causes has been 
admitted, and then the canker has been attributed to irritating 
muds and the excrementitial liquids of stables ; their contact often 
giving rise upon the skin, ujDon the glomes of the frog, to an ery- 
thematous inflammation, soon followed by a serous flow, which ex- 
tends to the sub-horny structures and gives rise to an exudation 
in the laminae of the frog. This cause produces the rotten frog 
(thrushes) but not canker. We beheve that this cause has princi- 
pally been admitted by veterinarians who look upon thrushes as 
the first stages of canker, but this is not so, and for canker to 
develop itself under similar conditions, others are necessary, which 
are as yet unknown. 

Canker has also been attributed to narrow and contracted feet, 
so common in horses of meridional climates, and in which the sole 
is very concave, with the frog and pyramidal body shrunk in. 
Often in the laminae of these feet a sero-purulent moisture is dis- 
covered, more or less offensive, which is a rotten frog, but not 
canker, and but seldom followed by it. 

To produce canker a simple irritation of the sub-homy struct- 
ure is not sufficient. There must be a special cause, proper to 
canker, stimulating alone the characteristic changes of the cause. 
This cause we find in the cryptogam which characterizes canker, 
propagates it, and which has no power of spontaneous existence. 



DISEASES. 601 

As with other parasitic diseases, canker is communicable by- 
contagion ; although the examples are quite rare they cannot be 
doubted. Hutrel, d'Arboval, Plass, Blind and Megnin have ob- 
served them, and in all the cases dampness has contributed to 
the propogation of the cryptogam. 

The lymphatic constitution in an animal is eminently propi- 
tious to the development of canker, as it is observed to be, in fact, 
for all parasitic diseases. 

It is known by daily observation of facts that horses whose 
skin is thick, with the hairy system well developed, the feet flat, 
with thick frogs, are more often affected with canker than animals 
of a nervous constitution. It is more particularly observed in 
horses with much white at theii* extremities, with stockings and 
white feet, and in those where there is a tendency to albinism. 

An unknown diathesis has also been considered as causing a 
predisposing constitutional organic condition, but this has not 
been justified by observation. It may happen that canker cured 
or dried on one foot, may attack another foot, perhaps a third, 
and then a fourth, to re-appear in the first ; this character of the 
disease has often been mentioned as proof of this diathesic condi- 
tion ; but it may also be explained by its contagious character. 
The disease remains too much localized to be constitutional, as 
generally in diathesic diseases we have critical eruptions upon 
different organs or different tissues. 

Treatment. — From the preceding remarks, it is evident that 
in feet affected with canker, the keratogenous apparatus of the 
foot has undergone no essential alteration in its structure, that its 
thickness and density have only increased by consequence of the 
infiltration and organization in its net- work of the plastic products 
of inflammation. And, again, the secreting function of this appa- 
ratus, far from being arrested, is on the contrary, more active ; but 
the products it gives instead of being concrescible, remain difflu- 
ent ; hence the impossibiUty for the hoof to be restored in the 
regions where this alteration of secretion exists and remains. 
These important facts, says M. Bouley, must take the lead in the 
chapter of the therapeutics of canker, because they teach the 
practitioner that the object to effect, in the treatment of this dis- 
ease, is not to radically destroy the diseased tissues, as has been 
too often done and recommended, but to return to them their 
physical and physiological properties by the application on their 



602 OPERA.TIONS ON THE FOOT. 

surface, of modifying agents which influence the nutritive and 
secreting functions of their tissues without interfering with their 
structure. To reach this point, the most varied pharmaceutical 
agents have been recommended, the most successful being those 
which at the same time had parasiticide properties. We, however, 
find it difficult to give the preference to any of them ; and we have 
now more faith in the modus faciendi, to the skiU of the operator, 
to the continued use of dressings properly applied, than to such 
or such agent; all of those which have been recommended if 
methodically appHed, can cure canker, and it will be wise to em- 
ploy them alternatively ; when one fails at first it is prudent to 
try another ; canker is a disease so often rebellious to treatment, 
especially when confined to the lacunae of the frog, that too many 
remedies cannot be used. 

The first indication is to remove the excess of the horn of 
the wall, the length of which, we have said, is often very great ; 
then prepare a convenient shoe for the dressings. This shoe nec- 
essarily varies, as canker is exclusively localized to the plantar 
surface of the foot or extends to the podophyllous laminae. Gen- 
erally an ordinary shoe is used, more or less covered (wide) and 
so hoUowed as to allow the free appUcation of plates by which 
the dressing is kept in place. When the condition of the disease 
requires the removal of large pieces of horn, a truncated slipper 
is used, proportioned in cutting to the extent of the parts of the 
wall upon which it is to be appHed. There are circumstances even 
when shoes cannot be used, so much does the disease extend 
under the wall. It is then necessary to use a shoe without nails, or 
boots, secured to the coronet by means of straps. In all cases the 
rule is to take care that the dressings remain fixed in the most 
exact manner, and that through them a methodic, steady, but not 
excessive pressure is constantly appHed over the diseased parts. 

The first step of the operation passed, the next consists in 
the removal with proper instruments of aU the loose portions of 
the horn, either at the plantar surface, at the quarter, or at the 
heels. One must avoid, in this operation, the excision of soft 
parts ; but the important indication is to follow the disease where- 
ever it exists, and to leave no part of the horn which may have 
been detached by morbid exudations. Better cut the healthy 
structures, and have them bleed, than to neglect to completely 
expose a diseased part. This done, the horn is to be thinned as 



DISEASES. 603 

much as possible, upon the circumference of the diseased spots, in 
order to give a suppleness which would ease the swelling of the 
uncovered parts. 

Upon the exposure of the disease where it exists, the fici exist- 
ing on the surface and edges of the velvety tissues are to be 
removed with the scissors or sharp sage knife ; at the same time 
the parts of horn which may have remained are to be cut off, 
avoiding, however, the healthy tissue beneath, which still retains 
its normal character. 

When the canker is very extensive, so that the wall is loose on 
each quarter, or on all its circumference, it is of advantage to pro- 
ceed in the requu-ed operations at different times. 

This done, the shoe can be put on ; after which the diseased 
surface and surrounding horn are to be covered with a thick layer 
of the medicamentous preparation. If this is in form of a paste, as 
is often the case, it is spread over with a spatula. If in powder, 
it is thrown over it carefully. If liquid, balls of oakum are soaked 
with it and placed on, the whole being then kept in place by pads 
and plates. The important point is that the dressing should be 
so appHed as to be easily changed, that an exact, regular and 
sufficiently strong pressure be kept on. No better means can be 
used for this than the di\dded plates already referred to. 

In canker the dressing must be renewed every day, and even 
twice daily at the beginning of the treatment. This is an essential 
condition of success, whatever may be the therapeutical agent 
employed ; and this is not a simple difficulty in practice where the 
patient is not always of easy access. Moreover, this dressing is 
somewhat comphcated, and can only be skillfully made by the vet- 
erinarian himself. 

It often occurs that upon the removal of the first dressing, (the 
second day) one finds the tissues already covered by a layer of 
hardened horn, adherent to the surfaces. One must then, with 
the finger, a spatula, or a dry pad of oakum, rub it off where it is 
found loose and movable and, if necessary, renew the apphcation 
of the dressing. The same must be done at the other dressings, 
carefully watching if this new horn thus formed by the influence 
of the medication, is not separable from the parts underneath by 
the different morbid secretions of the disease. One must then 
carefully scrape off all that is not adherent, and thin the edges, 
and the projections of all the horn which retains its soundness ; 



604 OPERATIONS ON THE FOOT. 

the caseous substance being also removed ; the same compressive 
dressing to be put on again. 

The modification in the homy secretion, and the formation of 
a layer of hardened and adherent horn, are especially great in the 
parts where podophyllous and velvety tissues exist ; but are very 
slow, and surrounded with difficulties in the median and lateral 
lacunse of the frog. After ten days of treatment, one may have 
brought about a normal secretion on the whole circumference of 
the sole, on the inferior face of the os pedis, and on the prominent 
parts of the pyramidal body. But in the lacunse the alteration 
remains isolated, and resists treatment ; and it often happens that, 
if neglected, it may again spread and the disease reach its former 
extent. It is then the case, when the disease is limited to the 
lacunse, to add to the ingredient already in use and which is kept 
applied upon the restored parts, another stronger and more active 
agent, sometimes simply absorbent ; here again it becomes diffi- 
cult for us to advise the practitioner, the number of recommended 
drugs being very large and the result depending less on their 
nature than in the intelligent and persisting manner with which it 
is apphed. When caustics are used, it must be done with great 
care, to limit their action only to the thickness of the keratogen- 
ous tissue, and not to carry it to the destruction of the bone, or 
still worse, of the plantar aponeurosis. 

Let us glance at the drugs which have proved most successful 
in the treatment of canker : First we have the different pyrogen- 
ous preparations, especially wood tar, recommended by Bracy, 
Clark, Eeyual and Bouley, and which give astonishing results. Gas 
tar, oil of cade, petroleum and soot have also been used, but with 
less advantage ; creosote and phenic acid have often shown them- 
selves very useful, by penetrating easier to the base of the vHlosities 
where the parasite resides and thus acting more regularly ; phenic 
acid proved very useful with Krause, Gerlach and Zundel. 

After these the best recommended preparations are the salts of 
iron. Hertwig seems to be well pleased with the powder of sul- 
phate, and Arnold recommends the jDyrolignite of the same metal ; 
Megnin advises specially the perchloride, which, like phenic acid, 
is rather a powerful astringent than a true caustic. The prepar- 
ations of copper have also had their time, and especially the aceta- 
tes, such as the CBgyptiacum ointment (Girard, Schaack, Kainard 
and Key) ; the baths of sulphate of copper were employed by 



DISEASES. 605 

Verrier, Jr., of Rouen; a solution of sulphate of copper and of 
zinc in water or vinegar were recommended by Delaval and Haub- 
ner ; SoUeysel employed the prej)arations of copper, but added to 
them arsenic and other drugs ; Eichbaum preferred the powder of 
chloride of lime, and Rauch ordinary Hme, while Aubry employed a 
mixture of lime and caustic potash. 

Caustics were well recommended by other practitioners, but 
their prescriptions seem to be contrary to the rule we have laid 
down in the beginning. However, one must not forget that the 
tissues of the foot, especially when diseased, offer an extraordinary 
resistance to the action of caustics ; they are, so to speak, impene- 
trable, and the irritation they produce remains superficial, while 
where those tissues are healthy such agents produce a deep cau- 
terization. Again, this resisting force of the indurated tissues 
against the actions of caustics is limited, and it is possible that 
one, two or three applications may apparently remain inefficacious, 
where a fourth or a fifth will give rise to extensive cauterization. The 
result is explained by the repeated irritating influence of the caustic 
agent, which, by gradually increasing the vascularity of the parts it 
touches, increases also the means of their absorption and imbibition. 
These facts must also be present to the practitioners mind, and 
it is by them that he will be guided in their use, rendering them 
at wni, simply modifying, catheretic, or deep caustics. 

Nitric acid was used by Percivall and Delorme, the latter con- 
sidering it the best means in use. Sulphuric acid has also been 
employed, seldom alone, but mixed with agents likely to reduce 
its effects and render its applications more convenient. Collignon 
and Renault recommend its reduction with alcohol ; Mercier 
mixed it with four parts of oil of turpentine ; Prange with equal 
parts of tar, and Plass made a paste of it with burnt alum. This 
last remedy, very simple in its formtda, was applied without any 
dressing ; it has proved most excellent in a great number of cases, 
but may give rise to too deep cauterization (Bouley, Mendel). 

Arsenious acid was much used by old horsemen, combined with 
oegyptiacum, turpentine and other ingredients. Hoffmann prefers . 
the arsenite of soda in solution ; he sold his secret to the Austrian 
government for a high price. Butter of antimony was recom- 
mended by Huzard Sr., Prevost, and especially Huzard ; chloride 
of zinc was preferred at the Lyons school. 

The treatment of canker by actual cauterization was indicated 



606 OPERATIONS ON THE FOOT. 

by SoUeysel, but soon abandoned by him. In applying- the cau- 
tery upon the uncovered tissues of the hoof, we encounter the 
chance of jDroducing a very severe inflammation, which spreads by 
degrees and gives rise to extensive slough of the hoof, as a con- 
sequence of the serious exudation which takes place ; the action 
of the cautery may then become either too mild or too vigorous. 
Still, it has been recommended by Prevost, of Geneva. Hurtrel 
d'Arboval, who also employed it, used it in the following manner: 
the parts being covered with a mixture of gunpowder and sulphur, 
a red-hot iron was applied to the spot, the powder burning sud- 
denly and the sulphur slowly. If the combustion was too slow, 
he increased it and kept it up by the same means. When the 
operation is concluded the parts are transformed into a black scar, 
which can be easily removed by scraping, and the application and 
cauterization may be repeated, and so on until it appears that a 
sufficient amount of heat has penetrated the tissues to destroy the 
material by which canker may be regenerated. The cauterization 
being once properly effected, then in order to sustain irritation, 
the foot is covered with Burgundy pitch, or resin, melted and 
warm, which is allowed to cool off on the foot, when a dressing of 
oakum and the shoe are put on. The dressing is changed as soon 
as suppuration shows itself and renewed with the same ingredients 
in the same manner until the wound becomes healthy and granu- 
lating. 

It is only for the sake of the record that we refer to the ex- 
clusively surgical treatment, based upon the erroneous idea that the 
fici of canker are abnormal products, deejDly implanted in the 
tissues beneath, and where it was advised to look for the imagin- 
ary roots of these fici at their extreme limits. In this treatment, 
not only the diseased horn was removed, but the entire sole, the 
plantar cushion and often the plantar aponeurosis was excised. 
This practice, advised by Lafosse junior, was also recommended 
in the veterinary schools by Chabert in France, and Dieterichs in 
Germany. It prevailed for a long time, though experience showed 
.that the wound resulting from such an operation was of very slow 
recovery, that the frog especially could not be regenerated, that 
there remained a central ulcer, and that it gave rise to such a mal- 
formation of the foot that the animal remained lame for a long 
time, sometimes for life. Notwithstanding these objections, ob- 
served by Jeaune, Girard and Eichbaum, this treatment is still 



DISEASES. 607 

followed by a few who prefer it to the simple operations of SoUey- 
sel, which consists in the division of the loose pieces of horn and 
the excision of the fungoid projections. 

We have thus far only spoken of the local, without referring to 
the internal or constitutional treatment of canker, recommended 
by those who look upon the disease as constitutional. Without 
beUeving that it can have any real curative effect, we, however, 
admit its usefulness, when the disease is of old standing, and that 
the animal has suffered much by it. Ferruginous preparations 
are specially advisable^ and we prefer the carbonates that are used 
by Delwart to the sulphates recommended by Prevost, Delaval 
and Hertwig, and it is well to unite them with bitters and tonic 
powders. Arsenious acid is prescribed internally by Delaval, 
Feuillette, Niederberger, Obich ; and other alteratives, such as 
mercury, which we would not advise. Nor can we understand 
how any benefit is to be derived from diuretics and purgatives, 
and especially from the use of external emunctories, such as 
setons. 

Corns. 

Under this name is understood an alteration of the tissues 
underneath the hoof ; of the heels of the horse's foot by lesions of 
the hving parts in the movements of expansion of the hoof ; by 
bruises, compressions or contusions. There is then a capillaiy 
hemorrhage which extends in ecchymosis in the hoof. A corn, 
then, is a bruise of the Hving horn at the extreme end of the 
branches of the sole, and especially in the laminated tissue of the 
folds of the bars. It is a very common disease, and one to which 
all horses are exposed. Some have them constantly. 

Corns are seen mostly on the fore feet, and on the inside 
more commonly than on the external side. They are rare on the 
hind feet,. because in the various gaits the weight of the body is 
carried more on the front legs and on the posterior part of the 
foot, while in the hind legs it is the front part which principally 
receives it. 

I. Divisions. — Lafosse Sr., has distinguished them into natural 
and accidental, while Girard considers them all as accidental. H. 
Bouley designates as essential those which come from other than 
external causes. We believe that it wovild be better to estabUsh 
the divisions on pathological and anatomical bases, and admit a 



608 OPERATIONS ON THE FOOT. 

corn of the wall, or laminated, that which has its seat in the 
laminae which unites the wall to the tissues underneath, viz., in 
the keraphyllous and podophyllous tissues of the heels and bars, 
and a corn of the sole, or velvety, that which has its seat in the 
velvety tissue which unites the sole to the fleshy parts. The 
laminated corn corresponds exactly to the " natural " of Lafosse 
and to the " essential" of Bouley. It is due to lacerations in the 
movements of expansion of a badly-made foot. The other is due 
■ to contusions. \\Tiatever may be the adopted divisions, we, with 
Girard, and as admitted in practice, recognize in each category, 
the dry, the moist and the suppurated corn. 

n. Etiology. — All feet are exposed, but not all predisposed to 
corns. They are more frequent in heavy feet, with those where 
the heels are high or contracted in which there is a motion of re- 
traction of the hoof which interferes with the displacement back- 
ward of the third phalanx at the time of rest, and hence the lacera- 
tions are easy ; besides, there is a continual pressure upon the 
living parts of the posterior region of the nail. Corns are fre- 
quently observed in excessively long feet where the hoof does not 
receive the moisture necessary to its elasticity ; it then losses its 
suppleness and fails to assist the internal motions of the parts 
contained within. It is seen whenever the hoof is too dry, the 
posterior diameter of the feet being then diminished. Corns are 
seen on weak feet, on which the hoof is too thin to resist the 
dilating effect of the internal structure, and spreads excessively. 
"Wide and flat feet, with low heels, in which the interior surface of 
the branches of the sole is on a level with the plantar border of the 
quarters and bars, are very often affected with corns. The pres- 
sure of the shoe or the roughness of the ground produce these 
bruises through the sole. Here the conditions are unfavorable 
to the normal dilatations of the hoof ; the ungeal phalanx, being 
unsupported by the convexity of the sole, has a tendency to drop 
down lower, the tissues are easily lacerated and bruised in its dis- 
placement at the time the foot rests on the ground. 

The most serious causes of corns arise from the shoeing, which 
not only sometimes gives to the hoof a shape predisposing to that 
disease, but also very often is a determining cause itself of these 
injuries. " As long," says Hartmann, " as horses will have corns, 
horse-shoeing cannot pass as an art, and their too frequent pres- 
ence is an evident proof of our imperfect means of protection to 



DISEASES. 609 

the hoof." Without shoeing there would be no corns, and it is in 
its irrational methods that the true causes of thfese accidents 
originate. It is by the greater or less frequency of corns that one 
may judge of the state of that art in a country. 

The faults are found, 1st, in the manner in which the foot is 
pared, or in the shape which it receives ; 2d, in the fitting of the 
shoe ; 3d, in its application. In paring the foot, the sole is often 
weakened and thinned too much ; it does not resist the pressure, 
and, at the time of resting the foot, all the weight of the body is 
thrown upon the point of union of the sole with the wall. Ordi- 
narily too much has been cut away from the frog, and this not 
resting any more on the grovmd, no longer resists the pressure, 
and the lowering of the branches of the sole is then extreme, as 
proved by the experiments of Leisering. The custom of cutting 
the corns, and of cutting the hoof at the heels, acts in a similar 
manner ; the posterior half of the foot is weakened, and that is 
the part which must carry the greatest part of the weight. One 
needs only to compare a foot from which the shoer has removed 
much horn at the sole, frog and bars, with one in which the hoof 
has been left alone for a long time. In making a vertical and 
tranverse section of the two in the middle of the frog, a little in 
front of the angles of the sole, he wUl see at once how weak the 
point of reunion of the sole with the waU has become, the means 
of resistance to the pressure of the weight of the body through 
the third phalanx being thus diminished, and consequently a pre- 
disposition to bruises created. 

The shape of the shoe also contributes to corns ; an excess of 
concavity ; a shoe which from the last nail-hole is not flat to the 
heels, whose branches are too much inclined, contributes to the 
lateral contraction of the foot and gives rise to corns. In this case 
the shoe resists the play of the horny box, and by itself, through 
the sole, exercises a great pressure upon the tissues underneath. 
Too high caulks, in preventing the resting on the frog, cause an 
excessive pressure on the inside of the foot, and compel it to rest 
on the heels and the branches of the sole, which are too much 
lowered; The opposite excess, when the shoe is thin at the heels, 
as in the Coleman shoe — which is thick at the toe and thin at the 
heels — produces a similar result, because in increasing the pres- 
sure on the heels, it gives rise to bruises of the tissues through 
the retrossal processes, which comes down too heavily. A very 



610 OPEKATIONS ON THE FOOT. 

wide shoe, too thin, may also contribute to the genesis of corns, 
because, then, the shoe helping, with the intensity of the reactions 
on the pavement or on too hard and stony roads, the shoe soon 
gives under the foot, and compresses the sole and tissues beneath. 

The manner in which the shoe is put on may also be a cause 
of corns ; the shoe ought to rest exclusively on the inferior border 
of the wall, and not touch the sole ; when it is too narrow it may 
be a cause of contusion or of contraction ; if too wide it prevents 
the natural expansion. It is upon horses long shod that the wrong 
apphcation of the shoe as a cause of corns is observed. As a con- 
sequence of the growth of the hoof, the shoe no longer sufficiently 
protects the plantar border of the foot, the heels of the shoe being 
inward and pressing on the branches of the sole ; this is especially 
the case when the shoe is thinned by wearing ; it yields, and easily 
bruises the parts of the sole on which it rests ; high caulks, on a 
branch already too ghort, or too thin, act the more injuriously be- 
cause, not being concentrated on the projection of the caulk, the 
branch gives away sooner, and presses still more on the heels. 

The shoe becomes an indirect cause of corns, when hard sub- 
stances, as stones or dry earth, are found between its superior and 
inferior face on the sole, or between the frog and the internal bor- 
der of the branches of the shoe ; this is a secondary cause, which 
was formerly considered of great importance. 

The work of horses has a great influence, corns being very fre- 
quent in horses which work on pavements and stony and hard 
roads. They are rare in country horses, but common in those of 
great cities ; a rapid gait contributes to their development on 
account of the great pressure on the ground. The seasons have 
also an influence, dry and warm weather depriving the hoof of its 
moisture, and by preventing its elasticity of motion, increasing the 
effect of pressure upon the tissues. 

Emigration has been considered a cause of corns. Horses 
coming from the north of Germany are mentioned as having been 
rapidly affected by them after being in large cities. But if the 
change too suddenly made from soft to dry bedding is an effective 
cause, the mode of shoeing can also be considered as a stimulating 
cause. The same is true with respect to the African horses, which 
are generally free from the disease in their native coimtry, but 
frequently suffer .with them when brought to France, and submitted 
to a mode of shoeing so different from that of the Arabs. 



DISEASES. 611 

m. Symptoms. — The ordinary symptoms of corns are noticed 
in the abnormal position of the leg at rest, in the lameness and the 
sensibihty of the region. 

When lame with a corn the horse carries the leg forward of 
the plumb Hne, and keeps it semi-flexed at the fetlock; he tries 
to reUeve the painful region by resting ; sometimes he manifests 
his pain by pawing and moving his feet from forward backward, 
pushing his bed under him. The lameness is not characteristic ; 
it varies greatly in intensity, from a slight soreness to lameness on 
three legs. It is generally proportioned to the intensity of the 
disease. However, there are horses so accustomed to their corns 
that they do not go lame, while others are very much so for a 
trifling injury. Sometimes it is intermittent, and diminishes when 
the suppuration has made its way between hair and hoof. The 
sensibility of the heel — seat of a corn — is discovered by an explo- 
ration with the blacksmith's nippers. Sometimes it is made known 
by pressure of the fingers, the cases varying, of course, according 
to the severity of the disease. There is often heat, especially at 
the coronet, which may be tumified, particularly so when the corn 
is of a comphcated suppurative character. To obtain an accurate 
view of the disease the foot should be well pared, and this opera- 
tion may be greatly facilitated by the application of poultices for 
twenty-four or forty-eight hours previously. 

It is only by the objective examination and the pathological 
anatomy, so to speak, of the com that the moist or suppurative 
variety can be distinguished from the di-y, and we shall find either 
a simple ecchymotic spot, or a complete disintegration of tissues. 

rV. Pathological Anatomy. — The lesions vary according to 
the severity of the disease. In dry corn, we find an infiltration 
of blood in the homy structure. This is blood which has transu- 
dated through the laminated or irritated velvety tissue from the 
injured blood vessels. This blood gives to the hoof various tints, 
more or less pronounced, not unfrequently yellowish, according to 
the intensity and duration of the disease. The hoof sometimes 
loses consistency and becomes brittle ; at others, it is hard and 
dry, and then resembles healthy hoof minus its coloration. If 
the ecchymotic spot involves the whole thickness of the horn, 
from its surface to its depth, it is an evidence of the continued 
activity of the cause. A deep mark indicates a recent injury ; a 
superficial one is an evidence of an older corn, which disappears, 



612 OPERATIONS ON THE FOOT. 

and then it seldom produces lameness. Sometimes the marks are 
arranged in layers, the healthy horn being alternated with others 
which are infiltrated with blood. This is a proof of the intermit- 
tent character of the acting cause which has originally produced 
the corn. The ecchymosis, however, is not the actual seat of the 
corn, which is more in the velvety and especially in the laminated 
tissues, which are torn or bruised, the blood escaping through 
the sole simply by the action of the laws of gravitation. It is 
rarely that this lesion is looked for in the case of dry com, and it 
is usually ignored ; but in the confirmed com, a true alteration of 
the laminae of the keraphyllous tissue is observed. This is re- 
placed by a homy tumor, a kind of keraphyllocele, analogous to 
that of chronic laminitis, due to a union of the laminae under the 
influence of the fibro-plastic exudation resulting from the inflam- 
mation, which is of varying size, and presses more or less on the 
sub-horny tissues. In some cases, this horn breaks up Httle by 
little, and gives rise to quarter crack. The ecchymotic spots of 
the dry corn may vary in size ; they may range from the size of a 
pea to that of a ten-cent coin. At other times they may occupy 
the entire space between the bars and the walls of the foot. 

In moist corn, there is not only hemorrhage, but also inflam- 
mation proper, with serous exudation. The hoof is colored, as in 
dry com, of a brownish tint, due to the infiltration of blood which 
occured at the start ; on searching deeper, one will discover be- 
tween the hoof and the living tissues beneath a separation of 
varying dimensions, filled by citrine serosity. Most frequently 
this separation takes place at the line of the sole with the wall, 
and extends under both. The horny substance is then more or 
less impregnated with this serosity, and then has a charcteristic 
yellow appearance and a waxy consistency. 

In siqjpurative corn, or more properly, suppurating, the in- 
flammation ends in suppuration. The pus is secreted by the vel- 
vety and laminated tissues. It makes room for itself by gradually 
separating the hoof as its formation progresses. Before long it 
passes between the podophyUous grooves of the bars and of the 
quarters, the horny are lossened from the fleshy laminae, and in 
its ascending progress the pus soon makes its appearance between 
hairs and hoof at the quarter, at the heels, or at the glomes of the 
frog. It is not common for the pus to make its way through a 
hoof of too thick or resisting a nature, unless it has first been 



DISEASES. 613 

sufficiently softened by poultices and thinned down with the knife. 
This suj^puration, in the generality of cases, brings on serious 
compHcation, by the excessive pressure to which the sub-horny 
tissues are then subjected. Gangrene of the velvety tissue near 
the branches of the sole and of the podophyllous grooves which 
have been lacerated in the suppuration, are very common compli- 
cations. If the pus remains long in the hoof its gangrenous re- 
sults may extend to the os pedis, the latemal cartilage, the plantar 
cushion, and even to the plantar aponeurosis, and give rise to 
necrosis or caries of the bones, or to quittor, to a more or less 
variable extent. This sub-horny suppuration, which may some- 
times be considerable, as well as the compUcations accompanying 
it, are detected with the probe. 

V. Termination and Prognosis. — Resolution is a common 
termination of corns. But their relapse is common also, especially 
in feet predisposed to them by bad conformation. A kind of 
chronic condition of the disease, and one which is more liable to 
become serious than the accidental variety, is the ordinaiy ter- 
mination in this case. The mere extent of the disease is of less 
importance in the diagnosis than the predisposing conditions. 
Generally the dry corn is less serious than the moist one, and 
especially less than the suppurative. Comphcated corns, princi- 
pally in flat, wide feet, with low heels, by reason of iincertain, 
protracted and expensive treatment, are in general fatal, and 
necessitate the destruction of the patient. 

VI. Treatment. — The largeness of the space we have consumed 
in considering the etiology of corns will compel us to be brief in 
our remai'ks upon the ^^reye;i<i?je treatment. Shoeing, which is so 
often the cause of corns, may also be made a means of preventing 
them, even upon predisposed feet, if performed with intelligence 
and proper observation, based upon the anatomy and physiology 
of the foot. Generally speaking, one must not proceed rashly by 
changing too suddenly the mode of shoeing. We do not think 
that any one specified system of shoeing will with certainty j^re- 
vent corns, but we do believe that each case demands its special 
study and care. Usually, a flat shoe, and which has the heels 
rather thin but resisting, and which rests on the wall proper, even 
of the diseased one, if not too painful, is to be preferred. If the 
shoe is for a low-heeled foot, the heels of the shoe should be 
thicker in order to supply their insufficient height and to oflfer 



614 OPERATIONS ON THE FOOT. 

more resistance to the weight of the body. Sometimes the pro- 
tecting effect of the shoe must be completed by the use of a plate 
of gutta percha or leather between the foot and the shoe ; india rub- 
ber does not answer, as by its elasticity it interferes with the re- 
sistance of the shoe. It is absolutely necessary to preserve the 
hoof in a sufficiently supple condition, to effect which tar, hoof 
ointments and other greasy substances are used; Flaxseed meal, 
poultices of cow manui-e and salt water, a damp bedding, tallow 
in the hoUows of the heels, all are very good preventives and 
even curative means, which a careful hostler will not neglect. 
Paring the feet thin, as practiced by some, is very objectionable, 
and is a serious obstacle to the extirpation of corns. The feet 
shoiild be pared as little as possible, especially at the heels or in 
the lacunse. 

As for the curative treattnent, there are, according to H. Bou- 
ley, four indications to follow : First, remove the acting cause ; 
second, treat the injury it has produced; third, reheve the pres- 
sure upon the diseased region, until it has returned to its healthy 
condition; fourth, prevent the return of the injury. 

The first indication is easy to fulfill with the accidental corn, 
but often nearly impossible in that due to a bad conformation of 
the feet. The second indication varies according to the extent of 
the disease. Generally it is advised to thin down the hoof at the 
bruised part and its surroundings, so as to relieve the pressure on 
congested or inflammed parts. Still, we are not in favor of too 
much thinning of the hoof, and except under peculiar conditions, 
would practice it very slightly. Even in the moist corn, we be- 
lieve in leaving to the hoof a certain protective thickness. The 
pressure can be sensibly diminished by the application of chloro- 
formed oil, or of tincture of creosote ; they very readily penetrate 
the hoof, and act directly upon the inflamed parts. We believe 
that excessive paring, the "cutting out of the corns," to use the 
shoer's expression, is injurious, and predisposes to new corns, by 
weakening the region and promoting a more rapid desiccation and 
contraction of the hoof. In aU cases of dry and moist corn, one 
must avoid making the parts bleed, the exposure of the soft tis- 
sues, and all unnecessary cutting. Thinning is necessary in sup- 
purative corn, and has to be done over the whole extent of the 
separation of the horn, and a wide channel of exit made for the 
pus on the side of the sole. It is a wise plan not to remove the 



DISEASES. 615 

entire mass of the loosened hoof, as by this the dressing will be 
much facilitated. 

Cold baths are usefvd in aU cases of corns ; at other times 
poultices of bran or other material are preferred. Sometimes 
sulphate of iron or of copper are added to the bath, especially in 
the moist corn. In the suppiu-ative kind, when the suppuration 
is iiTegular, and when complications are likely to follow, warm and 
sHghtly aromatic baths are better, and after this, a dressing with 
tincture of creosote, renewed the same day or the next. Later, 
cold iron or copper baths may be used again ; if the suppuration 
has broken out between hairs and hoofs, injections of Villates' 
solution, after free escape of the pus by the plantar surface, are 
indicated. 

In the comphcated suppurative corn these means are insuffi- 
cient. We must cut deeper, and for this the animal must be 
thrown. Then, when the diseased tissues are exposed by the 
removal of the loosened hoof, the natvire of the lesion must indi- 
cate the requirements of the treatment. The velvety and podo- 
phyllous tissues, if gangrenous, must be excised as far as their 
diseased condition extends; carious bone is to be scraped, the 
fibrous and fibro-cartilaginous structures, if necrosed, are to be 
excised or cauterized, or sometimes left alone and watched, ac- 
cording to the pecuUar chai'acter and extent of their lesions and 
the extent to which they exist. Once operated on, a dressing with 
plates and bands is appHed, and the animal allowed to rise. 

It is by a pecuhar shoeing that, for some time, the painful heel 
must be relieved from supporting its part of the weight of the 
body, and protected from outside pressure. This is the "bar 
shoe." By the transverse bar, which unites both branches, it pre- 
sents a support to the frog and protects the heels. The resting 
of the shoe takes place equally upon the waU of the toe and of 
the quarters, especially the external, and it does not rest on the 
diseased heels which may have been first cut away. Some veter- 
inarians prefer the tnmcated, or the oblique bar shoe, or that with 
a bar forming an acute re-entering angle. Harfcmann recommends 
the first ; Mayer prefers the bar shoe in which the bar heels have 
been thinned down, and even hoUowed, to avoid as much as possi- 
ble the pressure on the diseased part ; this shoe has sometimes 
given us good results in horses with a weak frog. In many cases 
ordinary shoeing answers ; then the diseased hoof is pared down. 



616 OPERATIONS ON THE FOOT. 

The branch of the shoe in this case requires a greater thickness. 
"Whatever may be the mode of shoeing used much advantage can 
be obtained by the application of a sole of leather or of gutta 
percha. 

Sandobacks. 

Seinie of the French ; Hornspalt of the Germans ; Fissura 
of the Italians — are fissures or solutions of continuity observed 
on the walls of the foot, ordinarily very narrow, which follow the 
du'ection of the horn. Principally observed on the hoof of soli- 
peds, it has been seen also in ruminants, but rarely, and of httle 
importance. 

I. Division. — They may exist on every part of the wall. On 
the median line of the nail they are called toe-crack, and then are 
more frequent on the hind feet. They are rarely found on the 
outside or inside toe (the mamelles of the French), but commonly 
met with on the quarter {qtiarter-cracks), then situated on the 
lateral parts of the wall, toward the heels, and more frequently on 
the fore feet, especially on the inside. They are sometimes obUque, 
relatively to the thickness of the wall. Cracks are superficial or 
deep, according to the thickness of the wall involved. They are 
complete when they extend from the coronary band down to the 
plantar border ; hicomplete when more Hmited. In this last case, 
those which do not extend up to the skin are the more disposed 
to recovery, and will grow down with the growth of the wall, 
while those which extend to the coronary band are more serious, 
being continually aggravated as the growth of the hoof progresses. 
According to the date of their formation, they are called recent 
and old. ^iinple cracks are those which only involve the wall ; 
they are complicated where there is more or less serious lesion of 
the tissues beneath, such as infiammation of the laminse, hemor- 
rhage, or caries of the bone. A serious complication is that of 
keraphylocele. 

II. Symptoms. — Often the solution of continuity is the only 
one observed, and it is the special characteristic of the disease- 
But the fissure may be masked, either accidentally or by design. 
It may be concealed by the hairs, by the mud, or covered by hoof- 
ointment, tar, wax, or even a putty of gutta-percha. Concealed 
internal cracks have sometimes been discovered, such as fissures 
involving the internal face of the waU, which, consequently, were 



DISEASES. 617 

not noticed from the outside, or showing but a sHght depression 
on the surface of the wall. These cracks are only discoverable 
when the foot has been well pared down. As slight as the solu- 
tion of continuity may be, it participates in the motion of dilata- 
tion of the foot, and it is better detected when the foot is raised 
than when it rests on the ground. This is the case when it is a toe- 
crack, but on the contrary, the quarter-crack is more open when 
the animal rests its weight on the leg, ia which case, the sepa- 
ration of the borders of the cracks may be from two to four milli- 
metres, and may expose the bottom of the fissure. Ordinarily, 
cracks appear first at the coronet, and there is then but a sHght 
opening, but as they become older, and grow down, they have a 
tendency to become deeper and more complete. When of old 
standing, their borders are rough and scaly, having between them 
an ulcerated tissue and sometimes a fungus growth, from which 
escapes a sanious fluid. In other cases, as of quarter-crack, the 
edges have a tendency to cover each other. 

Superficial cracks are not always attended with lameness ; it is, 
on the contrary, often very severe when they are deep. The pain 
is generally in proportion to the depth and degree of opening of 
the fissure, and also especially to any compHcations which may 
exist in the tissues beneath. The lameness seems at times to be 
due to the injury of the deep, soft tissues, and to be caused by the 
motions of the horny box when they become pinched, iriitated 
and bruised. The affected animals are especially lame when the 
foot rests on the ground, and the lameness is greater on a hard 
than on a soft surface. If an animal suffering with toe-cracks is 
moved on descending ground, the lameness is greater than on 
ascending a hill, the weight of the toe in the latter case producing 
less opening of the edges of the solution of continuity. In quarter- 
cracks, the severity of the lameness is always in proportion to the 
rapidity of the gait; many horses which are but slightly lame on 
a jog, become much more so when the gait is accelerated, the dila- 
tion of the heels being greater, and the separation of the b rders 
of the crack increasing in proportion to the speed. When there 
is lameness, there is naturally an increase of heat and sensibility 
of the foot, especially at the seat of the crack. This is often dis- 
covered by feeling with the hand ; old cracks are generally accom- 
panied by a thickening existing at a corresponding point of the 
hoof. A deep, but recent crack, is apt to be accompanied with 



618 OPERATIONS ON THE FOOT. 

hemorrhage ; there is blood which sometimes exudes between the 
borders of the crack, and flows in abundance when the movement 
is rapid ; and old crack, in similar circumstances, may show pus, 
sometimes mixed with blood. A misstep, a sprain, may give rise 
to hemorrhage in cracks which are ordinarily dry. In toe-crack, 
the solution generally involves the thickness of the wall, through 
which it runs in a line almost parallel to the median plane of the 
body, while in quarter-crack it is often oblique and irregidar, not 
exactly following the direction of the fibres, but following the 
thickness of the wall obliquely in such a way that the external 
solution of continuity is more posterior than the external. If the 
crack is rather old, and the foot where it exists is contracted, it is 
generally incurvated, one border covering the other, and some- 
times they seem to be moulded on each other, so as to cover and 
conceal the true crack. 

III. Complications. — Among these we may first mention the 
inflammation of the recticular tissue, which is first pinched and 
injured. This may be followed by suppuration and local gangrene. 
Very often the disease is followed by necrosis of the os pedis, and 
caries of varying depth. In toe-crack cases have been seen of 
caries of the tendon of the anterior extensor of the phalanges, and 
even arthritis, though rarely occuring, have been observed. In 
quarter-crack, one may have cartilaginous quittor and suppurative 
corns. As before stated, thes'e lesions are indicated by the severity 
of the lameness, the presence of the blood or j)us through the crack, 
and the extreme sensibihty of the part. It is especially when, in 
the course of treatment, a part of the hoof has been removed, that 
the keratogenous apparatus has been exposed, that the abnorma- 
coloration of the podophyllous tissue is seen, in its swollen condi- 
tion and its sensibility to pressure, accompanied with the presence 
of the pus or sanious discharge, and at times the necrosis of the 
bone. Sometimes, also, foreign substances, as dirt or gravel, may 
be found introduced in the cracks, and acting as causes of irrita- 
tion to the sensitive tissues below. 

A complication, not so frequent, however, according to some 
authors, is that known as Keraphylocele, and which consists in an 
hypersecretion of horn, from the coronary band on the inside of 
the crack. Sometimes the horny growth remains sej)arate from 
the borders of the crack, and is adherent to the wall only by its 
base, towards the coronary band ; this is especially the case when 



DISEASES. 



619 



the wall has been thinned do-^\Ti or partly removed. In other 
cases it is adherent to the two borders of the crack, and this forms 
a natural cicatrix. This horny column, of varying length and 
strength, according to its age, presses upon the tissues beneath, 
and gives rise to severe lameness. With time there is correspond- 
ing atrophy of the podophyllous tissue, or even of the os pedis. 
This is often followed by a marked deformity of the hoof, and 
especially a deep fissiire, parallel to the direction of the crack. 
The soft tissues under the keraphyllocele often in time become 
harder, in consequence of the disappearance of the papillse ; the 
hoof then is no longer adherent to the tissues beneath, and so 
incurable cracks are the result. A double wall or false quittor 
have often also been observed. Thus deformed, the foot is always 
subject to lameness, even if the crack is cured. Contraction or 
atrophy of the frog have been observed with quarter-crack. 

IV. Progress, duration, teriuination. — Ordinarily, cracks once 
existing become worse. From being superficial and imperfect 
they become deep and complete as a natural result of the ordinary 
motions of the foot. If rest and some hygienic attention can be 
given, they may recover spontaneously, and disappear by the nat- 
ural downward growth of the hoof. This fortunate termination, 
however, is principally obtained when the crack is due to acci- 
dental causes, without deformity of the foot. 

V. Prognosis. — Simple cracks, superficial and iacomplete, 
especially arising from the plantar border, almost always recover 
under rational treatment, which has for its principal aim the pre- 
vention of increase in the size of the fissure. Cracks starting from 
the coronary band are always of a more serious nature, with a ten- 
dency to increase easily. Still they are no longer to be consid- 
ered incurable. Cracks in which the borders are much separated 
by the motion of walking ; those which are obhque ; those whose 
edges are. incurvated inward ; those where a portion of the wall 
is loose ; those which bleed, and those where there is a continued 
irritation of the sub-horny tissues, are the most serious ; and so 
much so, that they may requii'e quite serious surgical interference, 
and after all baffle the best skUl of the operator. 

VI. Etiology. — The causes of cracks vary greatly, and are 
often multiple in a single case. Seldom the result of accident, 
they are most commonly the combined effect of both a predispos- 
ing and an extraneous cause. A frequent one among others is 



620 OPEBATIONS ON THE FOOT. 

the relative dryness of the hoof, which then becomes excessively ' 
brittle. We have seen the conditions in which the hoof loses its 
natural flexibility, and shall here only state that alternate changes 
from dampness to dryness have as much influence as the dr^Tiess 
alone. Cracks are more frequent in animals working along damp 
than in those pulling in dry and stony roads. They are common 
in animals which after being kept in pastures are placed in good 
paved stables, with dry bedding. It is principally in these condi- 
tions we find the quarter-crack. During some seasons, while a 
term of dryness follows continued wet weather, the conditions are 
favorable to their formation, and they often assume an epizootic 
form. Emigration to dry cUmates is a frequent cause, by produc- 
ing the contraction of the ungueal structure. This last circum- 
stance explains why cracks are more common in army horses, 
which are called to go on long journeys during the warm days of 
summer But if the European horse taken to Africa suffers less 
from the disease, a similar result occurs to the African horse when 
brought to our climate. The Arabian horse readily contracts 
quarter-cracks in our stables, and with our shoeing. Animals with 
small feet, or with hard and thick hoofs, have a natural predispo- 
sition, which is also found in Hungarian, Russian or Tartar ani- 
mals. Feet excessively large are also easily affected with the 
disease, especially those which have canker or grease. 

Unskilful shoeing may predispose to cracks, and this is princi- 
pally the case if the wall is thinned or rasped down too much ; 
the same resutt is obtained from shoes which are too wide or too 
heavy, or which are kept on by too heavy nails. 

Feet with toes turned outward are predisposed to it, as in 
these the weight of the body rests more on the internal quai'ter, 
which being thinner than the external, give way the easiest. Con- 
tracted feet are subject to it. Quittor, suppurative corns, and 
some other diseases, are also predisposing causes. Among occa- 
sional or accidental causes may be mentioned traumatism, contu- 
sions of the foot and blows during work. The ser-sice of heavy 
trucking for heavy horses exposes the hind feet to toe-crack, 
especially if the pulling is done in going up hill or on slipj^ery 
pavements; mules' feet are very subject to it, and heavy falls in 
jumping and external blows are occasional causes. 

Heredity in cracks has been mentioned. We do not admit 
this, except so far as it belongs among the predisposing causes 



DISEASES. 621 

which may be transmitted, and we should object to an animal for 
breeding purposes though otherwise well-formed, if he were 
affected with cracked feet. 

VII. Treatment — Prophj'laxy ought to be the principal treat- 
ment of cracks. It is not always easy, however, to prevent them, 
and it becomes imj^ortant therefore, to treat them as soon as they 
appear. One ought at least to try to prevent them from becoming- 
complete and dee]3. This form of treatment may be called the 
hygienic, as it is not properly curative, and so long as the crack is 
not yet completely formed, the animal may be kept at work as if 
everything was normal. Curative treatment is that which is 
applied to the deep or complete disease, more or less complicated, 
and it most commonly consists in removing that portion of the 
wall which bruises and ii-ritates the tissues beneath, and in equal- 
izing the wound. In general, there is no necessity for haste in 
operating, the hygienic treatment being often sufficient to obviate 
the need of serious operations The distinction between the hygienic 
and curative treatment is not, however, always definitely marked, 
and quite often the two modes of treatment must be combined, 
both the hygienic and the curative being necessary. 

The lyrophylactic treatment consists specially in the apj^lica- 
tion of tonics, with the object of preventing the hoof from drying. 
Its normal hyrogoscopic condition must be preserved, and it must 
be prevented from taking up too much of the dampness of the 
ground upon which it travels, as well as from losing that which 
keeps up its flexibility. At times it must be rendered more moist 
and, according to the requu-ements of the case, recourse must be 
had to hoof ointments and other greasy substances, glycerine and 
astringent poultices. At the same time the shoeing must be care- 
fully attended to ; the shoe must not be too heavy nor too wide, 
and shovild be secured by nails of a proper size. 

The hygienic treatment has for its first and principal indica- 
tions to prevent the solution of continuity from increasing, from 
extending through healthy structure, and especially to new hoof, 
as this is secreted by the coronary band. The borders of the 
cracks must be prevented from separating in the movements of 
dilatation of the foot. The normal suture of the wall not being 
produced by the natural process, or at least producing it only in 
keraphyllocele, which is likely to be as injurious as the crack it- 
self, the borders of the crack must be brought together artificially. 



622 OPERATIONS ON THE FOOT, 

It has been supposed that this could be done with the putty of 
Defay's, a mixture of gutta-percha (2 parts) and gum ammoniac 
(1 part), introduced into the well-cleaned fissure, and pushed in as 
deeply as possible by a warm iron plate or a spatula. This putty 
is excellent for superficial cracks, but is insufficient to bring the 
borders together when the fissure is somewhat deep, or especially 
if it is irregular and sinuous. 

A better way, at least for toe -crack, is that which consists in 
suturing the edges of the solution of continuity by metallic clasps, 
which immobihze the hoof. This mode is always preferable to 
circular ligatures of wire or cord, which have the effect of interfer- 
ing with the natural elasticity of the hoof. Clasps only fix the 
hoof locally, and are an old means of treatment, having been used 
by Solleysel and Garsault. 

It was advised to perforate the horn through and through with 
a small punch, and pass a wire, which was bent over the crack, or 
twisted together at the ends. The same authority recommends 
the driving of a nail through both edges, and securing it tightly, 
as in the application of the nails of the shoe. This treatment was 
recently recommended by Haupt, Lafosse and Rey. The first of 
these professors takes an ordinary nail, with a small head, drives 
it through one edge of the crack, so as to come through the other 
at an equal distance from the point of entrance ; the nail being 
thus driven to the head the borders of the crack are then brought 
together, and the nail secured in the ordinary way. Two or three 
of these clasps are employed, according to the extent of the crack. 
Lafosse makes a groove on each side of the fissure about one centi- 
meter from the border, in a direction transverse to that of the 
fibres of the wall, which limits the passage of the nail. The nail 
is then introduced and secured as in the first instance. Rey 
makes a track for the nail first, by drilling a hole through the 
borders of the crack. The animal must be cast during these 
operations. 

The best kind of clasps or hooks are undoubtedly those of 
Vachette, which require special instruments for their application, 
but give a real solidity to the means of fixing the jDOsition of the 
parts. The clasjDS are all prepared, made of strong wire, bent at 
both extremities, and slightly sharp inwardly (Fig. 4.89). These 
are secured on the foot by a special nipper or forceps (Fig. 490) 
in the notches made on the wall with a special cautery (Fig. 491) ; 



DISEASES. 



623 



this cautery has its extremities flattened, the width of the clasp, 
ajDart from each other. The forceps used to secure these is strong ; 
its branches are flattened from side to side, and grooved inward, 
and sufficiently apart from each other, while it is open, to receive 
the clasps between its border; these branches, with the clasp, 
are exactly fitted to the notches made in the wall with the cautery. 



FIG. 489,— Clasps. 




Fig. 492.— Clasps applied in the 
Thickness of the Wall. 





Fig. 491— Cautery 
of Vachette. 



Fig. 490.— Forceps of Vachette. 



It is sufficient to press the branches of the forceps to close the 
teeth or extremities of the clasps, and bring firmly together the 
borders of the cracks. The number of clasps varies according to 
the case under treatment. 

A very simple mode of effecting reunion of the borders of the 





Fig. 493.— Toe Crack secured 
with Clasps. 



Fig. 494.— Quarter Crack secured 
with Clasps. 



624 OPERATIONS ON THE FOOT. 

crack is that of Hartmann. It consists in applying upon tlie wall 
a sheet of iron, adapted to its outside, and secured on the foot by 
two small screws. 

Clasps are of a certain utility for toe cracks, but they often fail 
in quarter cracks, on account of the thin condition of the wall, 
which is particularly well marked in some feet. If the Hving tis- 
sues are encroached upon, the clasp may give rise to complica- 
tions, and still it is in that region that the effect of the motion of 
the hoof must be prevented, and where immobility is essential, to 
prevent the separation and spread of the edges of the crack. 

Castandet has indicated a mode of treatment which has proved 
very successful, and which may be applied to both toe and quarter 
crack, where the fissure of the wall extends from the coronary band 
to the lower border of the foot. It consists in making a groove 
at about one centimeter on each side of the crack, which in depth 
extends to its bottom, which, when reached, is white. If the 
solution does not go to the lower border of the foot, these grooves 
are made obliquely, and so as to meet together at their lower 
termination, and form a V-shape. Thus the crack cannot increase, 
and it grows down without injury to the soft tissues. Castandet, 
after this operation, cauterizes the coronary band. 

The transversal groove, recommended by Levrat, which cuts 
the tissues in two and extends beyond the crack on each side about 
three centimeters, which goes down to the soft tissues of the foot 
and not beyond them, has for its object to diminish the effect of 
percussion produced by the contact of the foot with the ground. 
It, however, does not prevent the edges of the fissure from sepa- 
rating, as the groove of Castandet does. It is chiefly useful when 
there is a separation of the wall, or false quarter. At times a 
transverse groove has been made to prevent an incomplete fissure, 
starting from the plantar border, from spreading to the coronary 
band. According to Hartmann, a single hole drilled through the 
wall is, in most cases, sufiicient. 

Shoeing is of much assistance in the hygienic treatment of 
cracks. In toe cracks, the toe should be spared as much as pos- 
sible while the heels are lowered by paring, or by the application 
of a shoe thicker at the toe, or by the removal of the calks at the 
heels. "While Defays holds that the shoe ought to lie close and 
tight to the plantar regions of the crack, Hartmann, on the con- 
trary, advises the paring of that surface at the toe, so that the shoe 



DISEASES. 625 

cannot rest on the crack, and recommends the aj)plication of two 
clips on each side of the toe. 

In quarter cracks, it is recommended to lower the toe, to save 
the bars and the frog ; and when the crack is incomplete, and not 
accompanied with lameness, Defays recommends not to lower the 
diseased quarter, and to have the heels resting well on that branch 
of the shoe which shall be thick and straight. Schrebe advises a 
calk on that side. If the crack is deep, with excessive lameness 
and deep lesions, the quarters and heels must be pared down as 
much as possible, and a bar to be then put on, resting on the 
frog, if need be. An ordinary shoe, with a thick branch, may be 
sometimes employed. 

As pai"t of the hygienic treatment, we may consider the means 
recommended to increase the secretion of the coronary band. It 
is known that a shght irritation at that part of the foot is accom- 
panied Avith an increased secretion of hoof, which is sometimes 
svifficient to give rise to a new growth of healthy horn. One of 
the most common methods is to shghtly cauterize the coronary 
band with the iron. This was abeady known by old practitioners, 
who employed an S cautery ; but they committed the eri'or of 
burning the hoof too deeply instead of simply cauterizing the cor- 
onary band. Solleysel speaks of the cauterization of the band. 
Garsault mentions only the burning with three S's across the 
crack. Such cauterization could have no useful effect, and the 
deep appHcation of the cautery might be followed by serious com- 
plications. For these reasons Lafosse objected to them. In our 
days it is abandoned, and the coronary band only is touched by the 
cautery ; Castandet and Rey also employ it. Chemical cauteries 
have also been recommended, nitric acid by Laguerriniere, and 
more recently by Lafosse. 

Putty of corrosive sublimate and ointment of oxide of mercury 
are also in use, but have no marked advantages. Bhsters prove 
very beneficial, and also turpentine, as recommended by Lafosse 
and Rey, and the oil of Cade by Maiuy. Defays advises the putty 
of gutta percha, which is also used to conceal the clasps. 

The curative treatment is necessary whenever any complication 
attends the crack. If it is recent, antiphlogistics and rest should 
be first tried ; cold bathing, bhsters combined with hygienic treat- 
ment may then be sufficient. A single groove at the upper pari 
of the crack, near the coronary band, is often sufficient, or a re- 



626 



OPERATIONS ON THE FOOT. 




Fig. 495.— Operation of simple 
Too Crack toy the process of thin- 
ning down the wall in V-shape. 



moval of a V-shaped portion of the hoof, 
extending more or less deeply, accord- 
ing to the condition of the crack, care 
being observed to avoid the growth of 
vascular granulations between the edges 
of the crack. There are cases where it 
is not necessary to remove the segments 
of the hoof entirely down to the soft tis- 
sues, but only to thin them down and to 
apply over it a dressing of oakum, se- 
cured by several turns of roller band- 
ages. In all cases a bar shoe must be 
applied to relieve the pressure on the quarter where the crack 
exists. This is principally recommended by Prevost, Girard and 
others. 

If there are deep lesions of the sub-homy tissues, a piece of 
the wall must be removed, and the operation for radical cure be 
performed. It is an old operation, by which all diseased tissues 
are exjjosed. As little of hoof as possible is removed. In operating, 
two grooves will be made alongside and at some distance from 
the solution of continuity. The wall between is removed so as to 
expose the podophyllous tissues from the coronary band down to 
the sole, care being taken to avoid the tearing of the structure of 
the coronary band, and the diseased tissues are then removed. If 
the podophyllous tissue, it is excised with the sage knife ; if the 
bone is carious, it is scraped with the drawing knife. The whole 




Fig. 496.— Operation for Com- 
plicated Toe Crack B, by removal 
of a piece of the toe of the wall. 
A A. — Oblique grooves limiting 
the size of the piece to remove. 



Fig. 497.— Dressing for Complicated Toe Crack. 



DISEASES. 627 

is then dressed up with a shoe having the toe thinned down, and 
extending somewhat beyond the border of the foot. 

The cicatrization does not take place from the coronary band 
alone, but also from the horny secretions of the podophyllous tis- 
sues. The rejDair is then quite raj)id. The first dressing is re- 
moved after eight or ten days, and if everything goes on well need 
not be changed more than once a week. 

The animal is not to be put to work until the hoof has obtained 
a certain consistency. 

The operation for quarter crack is similar, except that only one 
groove is required in front of the crack, the tissues being exposed 
as in the operation for the removal of the lateral cartilages of the 
foot. 

Calk. 

Synonyms. — Kronen tritt (Ger.) — Atteinte (Fr.) — Thus is called 
a contusion, with or without wound, that the animal receives on 
the coronet, from the shoe of another foot, or from a foreign 
body, or by another animal walking behind or alongside him. 

The skin of that region is very thick, slightly extensible, not 
easily yielding to the imilammatory swelling ; there is commonly 
sloughing and mortification of tissues, accompanied with violent 
pain. It is frequent in animals that forge, also in very young 
horses or those which are weak in the lumbar region, and which 
interfere and cut themselves in walking. This lesion is also very 
common in the districts where horses are shod with high calked 
shoes, when the wound resulting from it is made by the internal 
branch of the shoe, which lacerates the skin of the coronet. 
Horses shod to travel on ice are commonly affected with it ; the 
injury being more or less serious according to the size and sharp 
condition of the calk. 

Horses ridden in ridding schools are often affected with it dur- 
ing the various evolutions of the haute icole. 

It is called single when the wound is sHght ; concealed when 
the pain is great and continued, as in the case where it takes place 
on the tendon, near the heels or the quarters ; horny when the 
contusion has taken place on the wall or at the coronary band ; 
complicated, when it is very serious and accompanied with other 
more severe lesions. It is always a horizontal wound or a tumor 
by contusion. 



628 OPEKATIONS ON THE FOOT. 

I. Symptoms. —It is ordinarily recognized by the wound or 
swelling which exists upon the parts. Often the horse is lame, 
and the affected part warm and painful ; sometimes the hairs are 
cut, the skin scratched or torn. There may be a slight bleeding 
at the seat of the wound. When the wall has received the con- 
tusion, the vascular network underneath may become inflammed, 
and then pus is formed between the teguments and the hoof, 
which then become separated. Sometimes even the lateral fibro- 
cartilage of the foot becomes irritated and swollen, and ulcerates, 
especially when the contusion has taken place on that part where 
the cartilage is ; in this case the injury may be complicated with 
cartilaginous quittor. 

In severe cases, one may recognize a furuncular calk, charac- 
terized by the mortification and sloughing of a portion of skin at 
the place where the contusion took place ; it is the cutaneous 
quittor of old hippiatry, with formation of a core ; this is always 
very painful, and the inflammation generally spreads underneath 
the wall. Bouley calls it gangrenous when there is unHmited 
similar mortification of the tissues ; in this case the slough in- 
volves large portions of the skin. At times it may be called phleg- 
monous, when an abscess forms itself under the skin, then the 
coronet is warm, thick and inflamed, and the pain is extreme. 
Then if an incision be made through the dermis in its entire thick- 
ness, an abundant bleeding takes place, generally followed by the 
resolution of the disease ; if there is already suppuration, it is at 
the same time immediately allowed to escape. 

II. Treatment. — If the injury is slight or recent, whether with 
or without wound, very cold water and the removal of the cause 
by taking off the shoe, are sufficient to bring on a cure. But if 
the contusion has been great and deep, recovery is more difficult 
to obtain on account of the suppuration which will follow. Then 
the application of poultices is indicated ; if there is formation of 
a core, and mortification of tissues, poultices of honey are espec- 
ially indicated ; in case of phlegmon, the poultice must be warm, 
and then incisions and counter opening must be made for the 
escape of pus ; afterward dressings are made with oakum saturated 
with tepid wine or tincture of aloes. 

When the caulking is horny, the use of emollient topics is in- 
sufficient ; an excellent way then is to obtain the required slough- 
ing of the tissues by actual cauterization — the iron heated to white 



DISEASES. 629 

heat ; by thus destroying a portion of the hoof and the soft tissues 
one will avoid the excessive pressure at the coronary band ; this 
may also be prevented by the thinning down of the wall with the 
sage knife ; but one must be careful not to remove too soon the 
portions of horn which may be detached. 

When the calking takes place at the heel, it is good — so as to 
prevent other complications — to pare the foot down, especially at 
the heel, to remove the divided hoof and transform the wound to 
a simple one which can be dressed, as already stated, or with 
digestive ointment secured by several turns of a roller. 

When there are wounds of the teguments, it sometimes hap- 
pens, if the immediate union has not been obtained, that the por- 
tion of skin forming the inferior edge of the wound turns down 
and that the granulations protrude, tending to form a kind of 
fimgoid growth. Chabert says that these must be cut off and 
dressed with oakum soaked in alcohol. 

Calking at the hind feet being the most severe, and those 
which are followed by the most serious compUcations, on account 
of the urine and droppings of the animal, which impregnate the 
wound, one can never be too particular in keeping them clean and 
dressing them well. When they end in cartilagioiis quittor, they 
must be treated as that disease usually is. 

As to the means of prevention, they consist in not placing the 
horses too close to each other in stables, fairs, etc., in not forcing 
them too much in their gait, in shoeing properly those which 
forge or interfere, and in placing or riding them in such a way as 
to avoid the possibility of their wounding each other. 

Punctured Wound or the Foot. 

Synonyms. — Naglebritt (German) — Nail in the foot (EngHsh) — 
Clou de rue (French). — In veterinary science this designation has 
been given to a punctured wound, often with laceration, some- 
times with contusions, either at the sole or frog of the foot of the 
monodactyles, and produced by sharp or cutting bodies, most 
commonly nails, upon which the animal steps. The form of these 
bodies, the direction they take, the force with which they pene- 
trate, and the part of the sole they enter, give rise to various 
lesions of varying gravity as they are older or as the injured part 
enjoys a greater sensibility. 

Etiology. — Nails, stumps of nails, are most often those which 



630 



OPERATIONS ON THE FOOT. 



are jaicked up in the streets ; at other times it is a metallic sub- 
stance elongated and sharpened ; again, there are pieces of glass, 
or other substances, such as bones or sharp stones, which are 
picked up and produce the wound. 

It is principally in the streets of populous cities, in the yards 
of builders, or on the grounds where buildings are pulled down, 
that horses are liable to receive these injuries. In rviral districts 
they are rare, comparatively, to what they are in cities. 

It is evident that horses with wide, flat, thin, softened hoofs 
are more exposed than those which are of different structure. 

I. Divisions. — Punctured wounds of the foot may be simple 
or siqyerjicial, deep ox penetrating. 

One of these bodies piercing into the frog requires to go in 
deep to be serious, as above the frog (which is itself quite thick, 
though formed by a soft and flexible horn) is the plantar cushion, 
a fibrous, soft and elastic mass, which offers a great resistance. 
If, however, the injuring body is a very long nail, which runs per- 
;pendicularly in through the frog at the plantar cushion, it may 
reach the terminal extremity of the perforans tendon, situated 
immediately under the plantar cushion, and penetrate the sesa- 
moid sheath. It is known that this sheath forms a sac of some 
dimensions, that it extends above and below from the inferior 
half of the coronary to the semi-lunar crest, and in its transverse 
axis extends from one retrosal process to the other ; the inferior 
portion of this sjoiovial bursa covers the plantar aponeurosis in 
its whole extent. Sometimes, again, the puncturing body pene- 
trates as far as the bone ; sometimes the navicular ; at others the 
OS pedis, and sometimes even penetrates into the articulation. 

II. Symptoms. — They vary according to the seat of the lesion, 
its depth, the mode of action of the penetrating body, length of 
time it has remained in the wound, and the nature of the lesions 
it has made ; all conditions which may change the character of 
the disease from a first degree, when the animal shows no evi- 
dence of pain, to the extreme point, where its life is in danger, 
and evens ends in death, by the excessive local alterations and 
the sufferings accompanying it. 

Often the first point which assists in the diagnosis of the case 
is the history. The driver has seen the horse become suddenly 
lame, has examined the foot, and found a nail more or less deeply 
imbedded ; or it is the surgeon who finds the nail in its hiding- 



DISEASES. 631 

place. The exploration of the part shows with certainty the nature 
of the lesion, the direction and depth of the woiind, as well as the 
physical condition of the body which has made it, and all circum- 
stances which allow a positive diagnosis to be made. 

Quite often the nail is no longer in the foot ; sometimes it has 
left its mark — an opening which can be explored ; often this is 
not visible at first sight, though the woiind may be even deep ; 
this is when the injury to the hoof has been very slight, and when 
the hoof has retracted on itself by its elasticity or when the open- 
ing is concealed by the dirt of the streets. It must be remem- 
bered that sometimes the penetrating body remains broken in the 
soft tissues after its entrance through the hoof. If the accident 
is recent, only a little blood may be found — Hqviid or coagulated 
— over the wound ; later, some serosity, more or less purulent, is 
observed; the pus is white or black, sometimes mixed with syno- 
vial fluid ; sometimes there are granulations on the bodies of the 
wound which protrude over the edges, commonly called proud 
flesh. Such are the first objective symptoms obtained by the 
exploration of the parts. Ordinarily they are insufficient, for it 
is not always easy to probe the wound. It then becomes neces- 
sary at the beginning to pare off the hoof all around the wound, 
and sometimes to hollow it at the point of injury, without going 
to the sensitive structure, however. In this way the exploration 
and the probing of the wound are rendered much easier. 

The pain, expressed by the lameness, is almost always mani- 
fested ; it varies according to the seat of the lesion and its depth. 
At first the intensity of the lameness does not give the exact 
measure of the disease, and often one may be led into error by it ; 
but it gives an exact value of the lesion when a few days have 
elapsed since the injury was received; if the pains are slight or 
absent, they indicate that the reparative process is going on well ; 
it is, on the contrary, interfered with by complications when, as 
time goes on, the lameness increases instead of becoming dimin- 
ished. Generally one can say that the injury will amount to 
nothing when the lameness is slight, while, on the contrary, seri- 
ous compHcations must be always looked for when it is great and 
remains on long, even when the first lesion has been slight and 
superficial. The wound, which has penetrated through the hoof 
only, has no symptoms, no sequelse ; the animal is not lame from 
it, or if he be the lameness is very slight, the foot resting entirely 



632 OPERATIONS ON THE FOOT. 

on the inferior surface ; when the resting takes place only on the 
toe, ordinarily the tendon is injured, possibly the synovial sheath; 
in cases where high inflammation exists the pain is very great, the 
animal walking on three legs only. 

The anatomical examination of the injured part teaches that 
the most serious punctured wound of the foot is that of the cen- 
tre of the foot, where the tendon, synovial sac, and where the 
articulations may have been injured. Forward of this the wound 
is less serious, even if it involves the bone. Posterior to it, it 
can only injure the plantar cushion. Under this condition the 
plantar region of the foot is divided into three zones ; one, ante- 
rior, from the toe to the point of the frog ; one, middle, extending 
from the first to the median lacunae of the frog ; and the third, 
anterior, covering the space left back of this to the heels. 

The most serious of the injuries to which the foot is liable are 
those caused by foreign bodies which penetrate the middle zone, 
that being the most compHcated portion of the structure. The 
symptoms will vary, according as the wound extends to the plan- 
tar aponeurosis, or only as far as this membrane ; or lacerates the 
soft surrounding tissues without touching it ; or it goes beyond 
this and injuiies the small sesamoid sheath, or even going deeper, 
severs the navicular bone, or its ligamentous attachment to the os 
pedis ; or reaches the last phalangeal articulation. 

A wound of the plantar aponeurosis is always very painful, 
especially when complicated with necrosis, in which case there is 
no weight put on the diseased leg, and continual lancinating 
pains and reacting fever are soon observed. The wound is then 
fistulous in character, and the suppuration then flowing from it 
meets with difficulties in its escape, which gives rise to a state of 
general i nflammation, and the foot becomes hot and very painful 
If the necrosed scar becomes loose and sloughs off, being de- 
tached by suppuration, improvement soon ensues, but as the ne- 
crosis of the tendon has generally a tendency to spread, there is 
an increase in the character of the symptoms. If the wound 
extends to the sesamoid sheath from the start, the synovial fluid 
is observed escaping, first pure, but soon becoming milky and 
piu'ulent in aspect, if the sheath has become inflamed, and easily 
coagulated in yellowish clots. The pain is then very great, much 
more so than when the aponeurosis alone is diseased. At times, 
by rapid closing of the plantar wound or obstruction of the fis- 



DISEASES. 633 

tula, a warm swelling forms itself in the back of the coronet, which 
raises the skin by degrees and becomes elevated, prominent at 
one point, and giving a feeling of fluctuation. This swelling ends 
in ulceration, and allows the escape sometimes of an abundant 
synovial, purulent discharge. 

The wound of the small sesamoid and of its ligament adds 
nothing to these series of symptoms. The probing of the tract 
will only determine it by the sensation of roughness which it will 
give ; but generally one must be careful in using the probe, es- 
pecially when the flow of synovia is absent. If the foreign body 
has pierced through the ligament, or has penetrated in the coffin 
joint, phalangeal arthritis is the consequence. The same result is 
likely to follow excessive inflammation of the foot and the macer- 
ating effect of the suppuration, in which case the tendon may 
soften down and give way. It may then also happen that this 
tendon retracts by the contraction of the muscular fibres, and can 
then be traced upward to the back of the coronet, or of the fet- 
lock, according as the giving way has taken place higher or lower. 

With arthritis there is a hot, painful swelling of the whole cor- 
onet, with diffused oedema above the fetlock and the cannon, and 
extending upward to the whole leg, compHcating the lesion by lym- 
phangitis, and painful swelhng of the lymphatic glands. Then sub- 
cutaneous abscesses are found round the coronet, with e-anerrene 
of the tissues ; while, again there may be only an extensive fibro- 
plastic exudation, which ends in calcarious organization and anchy- 
losis. 

In the anterior zone the only serious lesion met with is caries 
of the OS pedis, characterized by great pain, continual lancination, 
loss of the use of the leg, and high reacting fever. There is 
abundant bloody and foetid suppuration, and the probe gives the 
sensation of the soft resistance of the bone, of its rough condition, 
and its partial fragility. The caries having most generally a pro- 
gressive march, complications of separation of the hoof, to a vary- 
ing extent, are often seen ; the pus arrives at the surface between 
hairs and hoof ; and diffused gangrenes are also often seen, which 
extend as well to the podophyllous as to the velvety tissues. 

In the posterior zone, the only serious wounds are the lateral 
ones, which may injure the fibro-cartilage and become compUcated 
with their caries or quittor and fistula down to the lacunae of the 
frog, as we have seen in suppurating corn. 



634 OPERATIONS ON THE FOOT. 

Nails may penetrate the posterior zone tlirough and tkrough, 
coming out behind the coronet, without danger. The sub-horny 
suppuration may detach the frog and be the only serious compli- 
cation to be met with. 

As terminations of all these injuries we may see resolution, sup- 
puration, gangrene, softening of the tendons and phalangeal arth- 
ritis, and as sequelae, bony tumors of the coronet, and anchylosis. 
The most serious comphcations are the dropping of the entire 
hoof, the rupture of the tendons, tendinous and cartilaginous quit- 
tors, for the injured hoof, and chronic laminitis for the opposite 
one. 

IV. Prognosis. — This varies according to the seat of the 
wound. Less serious in the posterior than in the anterior zone, 
it is less in the last than in the middle, where the region is so 
complicated and the nature of the tissues so different. The depth 
of the wound has also some influence on the prognosis. Wounds 
of the plantar aponeurosis are more dangerous than those of the 
plantar cushion ; those of the sesamoid sheath are more so than 
those of the aponeurosis ; they are still more serious if the bones 
are affected; the worst of all is that of the joint. The direction 
of the foreign body and its simple or complicated action, will also 
influence the prognosis. 

This, we have already said, can be established by the severity 
of the lameness. The nature of the foreign body must also be 
taken into consideration ; if blunt, which crushes the tissues, it is 
more dangerous than if sharp and pointed. In a flat or convex 
foot, punctured wounds are more serious than in a well-made foot. 
They are less serious in heavy than in light draught horses, as the 
former, though they may remain lame, are still useful. The 
excitable condition of a patient will also alter the prognosis. 
Wounds of the anterior feet are more serious than those of the 
posterior. 

V. Treatment. — In all cases, the first indication is to obtain a 
natural cicatrization and natural repair, always more rapid and 
perfect than that which is gained by surgical interference. This 
is generally easily secured, and for this reason it is important to 
avoid too severe manipulation upon the injured foot. One must 
watch the progress of the disease, give the foot as much rest as 
possible, remove the shoe, thin down in its whole extent the plan- 
tar hoof, so as to avoid any pressure, and keep the foot in a cool- 



DISEASES. 635 

ing bath — ordinary cold water, to which often is added acetate of 
lead, sulphate of iron, or common salt, very beneficially. Poultices, 
cold preferable to hot, give excellent results. By this treatment, 
the progress of the inflammation is checked, and very often deep and 
serious wounds, even those where the tendinous sheath has been 
injured, are easily cured. If the lameness gradually diminishes, 
the case rapidly gets well ; at any rate, by this treatment, the inflam- 
matory process is diminished, and the painful pressure of the hard- 
ened and thick hoof is avoided. 

In the winter, when cold baths are of difficult application, 
chloroformed or carbolized compresses may be applied round the 
foot. The hoof is thus softened and the pain reduced. At other 
times a blister is applied round the coronet. 

If the lameness remains, or seems to increase, it is due to ten- 
dinous necrosis or caries, and it becomes necessary to operate. 
Must the surgeon then have recourse to an operation, and make a 
simple wound with his sharp instrument ? Or, is it still better to 
merely depend on natural resources, and assist them *? 

It is difficult to lay down any special rules. If the disease is 
old, if the necrosis has progressed and is still increasing, a serious 
operation becomes necessary. If the necrosis is recent, one must 
be guided by external indications. Notwithstanding (Renault 
remarks) one should not be too hasty, as the animal must neces- 
sarily be laid up for several months afterward. It is often suffi- 
cient, in a recently punctured wound, in order to avoid complica- 
tions, to modify the conditions of the fibrous tissues in the whole 
extent of the lesion, by applying substances simply antiseptic, or 
still better, slightly caustic. Rey employs the cold bath, in which 
he dissolves a pound of sulphate of copper for ten or fifteen 
quarts of water ; by this means he has secured the speedy recovery 
of severe punctured wounds. For a long time, and with the same 
object, we have been using a mixture of equal parts of suljDhate 
of copper and sulphate of iron, having first hollowed the foot 
downward around the source of the puncture, and the sole being 
pared down as thin as could be borne. 

H. Bouley prefers the application of pulverized corrosive sub- 
limate ; after tracing the wound to its bottom, he fills it well with 
the powder. This remedy was already recommended by SoUeysel, 
who used it in caries of the os pedis. Other practitioners prefer 
phenic acid, and claim for it great advantages. By the action of 



636 OPERATIONS ON THE FOOT. 

the caustics upon the fibrous tissues exposed to necrosis, or 
already in that condition, a double salutary result is obtained ; 
first, the transformation of the part, which is the seat of a pro- 
gressive gangrene, into a chemical eschar ; and, again, promoting 
the more active vascularization of the surrounding parts, and con- 
sequently their increased power of healthy reaction ; conditions 
twice favorable to the sloughing of the eschar, and the process of 
repair following it. 

When the wound has reached the os pedis, and this has become 
carious, a portion of the sole is removed, so that the suppuration 
can escape, the bone is scraped off, and a dressing of carbolized 
alcohol applied, kept on by a thin shoe or slipper, with tin plates. 

When there is a fistulous wound, through which synovia escapes, 
yet not purulent, caustics are recommended. SoUeysel preferred 
these, but blacksmiths used them so carelessly that they soon 
were discarded. Since, however, they have been employed again, 
not in powder, but as trochiscus. Eey recommends the corrosive 
sublimate in conic pencils, introduced to the bottom of the fis- 
tula ; by them he obtains an eschar, a solid clot, from the synovia, 
which closes up the wound and prevents the synovial flow, at the 
same time stimulating the granulations which close up the fistula. 

We have already said that these measures must be used only 
when the synovia is not purulent, as then the escape of morbid 
liquids may be prevented. It is not then uncommon to see 
abscesses forming at the back of the coronet ; generally not so 
serious as is usually believed ; not as much as those which take 
place in front and which are due to suppuration of the articula- 
tion. After the running out of those abscesses, sometimes the 
wound of the foot assumes a better aspect, the symptoms im- 
prove, and the animal recovers rapidly. Injections of a very weak 
solution of tincture of iodine, as well as the baths of copper or 
iron, are then very advantageous. Hertwig advises the introduc- 
tion of a seton through the sesamoid sheath 

This treatment is not always sufiicient, especially where the 
lesions are deep. All the diseased structures must be then ex- 
posed, and they must be removed and the wound changed into a 
simple one, which, well dressed, will heal without difficulty. The 
operation is required in proportion to the extent and nature of 
the lesion, and if this is recent and comparatively superficial, if a 
piece of the foreign body yet remains in the wound, or if its re- 



DISEASES. 637 

moval has resulted in the sloughing of a small piece of dead tis- 
sue, it may be sufficient, the foot being pared thin, as already ad- 
vised, to simply make an infundibuliform opening, various in size, 
so as to exjiose the bottom of the wound. For that purpose, the 
drawing knife or the sage knife is used, a light shoe is put on, and 
a dressing of digestive ointment, segyptiacum, or simply alcoholic 
mixtures, are kept on by plates. At times it is advantageous to 
assist the process of sloughing by the use of caustics, sulphate of 
copper, Villate's solution, tincture of iodine, etc. If the wound is 
near or at the heels, the branches of the shoe are shortened and 
an appropriate dressing is put on. Subsequent dressings require 
the same care. Cicatrization goes on and the hoof soon' returns 
to its normal condition. Sometimes the surgeon is called only 
when the inflammation is far advanced and suppuration already 
established. This peculiar condition is manifested by the sw^ell- 
ing and heat of the parts, the acute pains, and often the high fever. 
The wound then must be at once enlarged and the pus allowed to 
escape, and this is the true operation for deep punctured wounds. 

The operation becomes more serious if there is separation, 
partial or total, of the sole or frog, with a more or less advanced 
disorganization of the tissues underneath. If there is escape of 
purulent synovia, extensive cuttings are to be made. 

In olden times, to perform the operation of the deep punc- 
tured wound, the entire removal of the sole was performed, with- 
out distinction or exception and notwithstanding the severe pain 
following it. In our day, a portion of separated sole or frog 
only is taken off. This is done by shces, and only so far as neces- 
sary for the other steps of the operation. 

This operation is indicated when there is great pain, continu- 
ing without regard to what treatment has been followed. It is 
also when the plantar aponeurosis has assumed a greenish tint, 
diffused in its extent, without indication of a repairing process, 
with the marks of sloughing of the dead structure. The instru- 
ments needed are various : sage knives, single and double ; draw- 
ing knives of various sizes : a directory, bistoury and forceps. 

The animal, properly secured, and placed under ansesthetics, 
if too irritable (Bouley), the horny structures are removed where- 
ever the suppuration has separated them from the soft tissues be- 
neath, or the sole is only pared down thin, as well as the horny 
frog in its whole extent. 



638 OPERATIONS ON THE FOOT. 

This first step of the operation completed, the operator intro- 
duces a director into the whole tract of the fistula, and with a 
sharp sage knife a longitudinal incision is made, following the 
canula of the directory as a guide, above and below the fistulous 
opening, and in the direction of the antero-posterior axis of the 
foot. This done, with the sage knife held in full hand, with one 
cut the surgeon, by a deep incision, removes the greatest thick- 
ness of the tissues all around the longitudinal cut he has just 
made, transforming the fistulous tract into a conical infundibu- 
lum, whose apex is at the bottom of the wound. If then the apo- 
neurosis is not yet exposed, the operator removes with the for- 
ceps and bistoury whatever tissues still cover it. 

Then follows the excision of the aponeurosis. This is meas- 
ured by the extent of the necrosis. As a rule, it must reach a 
little beyond the diseased part, and by that operation the puru- 
lent synovia finds a free chance to escape. 

If the sesamoid is sound, it must be left alone, but if the 
diathrodial surface is roughened, ulcerated and on the way to 
desquammation, it must be scraped off with the narrow and long 
drawing knife. 

The complications of arthritis cannot be interfered with by the 
surgeon. It is by general antiphlogistic treatment, and by local 
and external applications that they must be treated. 

The operation ended, the dressing follows, and becomes one 
of the most important parts of the means of recovery. As light a 
shoe as possible is placed on the foot, a coat of hoof ointment, 
Venice turpentine, or tar, is applied upon the thinned sole ; pads 
of oakum, wet with alcohol, carbolized or not, are then carefully 
laid on the soft parts. 

Some practitioners cover them with oegyptiacum (Mandel) ; 
others simply with Venice turpentine (Lafosse). 

The pads or balls of oakum must not be too thick or hard, as 
no pressure is needed. The whole dressing is retained by plates, 
and several circular straps of tape above the coronary band. Cold 
water baths are always good afterward. 

In the subsequent dressings one must bear in mind that the 
work of repair, the granulating, is more rapid in the tissues of the 
plantar cushion and fleshy sole than upon the bone and tendinous 
tissue ; and that in this case it is longer than upon bone if this 
has been scraped. The result of this is a wound which presents 



DISEASES. 639 

various aspects iu its progress of cicatrization. It often has a 
handsome granulating appearance over its entire surface, while at 
the bottom there may be a clot of coagulated synovia covering the 
surface of the sesamoid and the edges of the wound of the plantar 
aponeurosis. A free escape of synovia must always be facilitated, 
and often the development of the granulations has to be con- 
trolled. If the cicatrization proceeds well and regularly, dress- 
ings need be changed but seldom, being satisfied with the cold 
bath, with copper solutions. 

Dressings can be made with tincture of myrrh or aloes ; some- 
times in the centre with tincture of iodine. At times caustics are 
again used, while at others, fragments of bone or of tendon have 
to be excised. 

The entire closing of such a wound may sometimes take place 
in a month ; but often, even without complications, two or three 
are required. CompUcations may easily make their appearance and 
interfere with the cicatrization. Sometimes pieces of necrosed tis- 
sues which remain at the bottom of the wound give rise to fistulous 
tracts, until they are entirely removed. In this case, twice as long 
a time may be necessary to a cure. The pain and intensity of the 
lameness after the operation do not acciirately indicate the nature 
of the disease ; the general phlogosis, especially the synovial in- 
flammation, always causes a special acute pain, which for from 
three to six weeks may prevent the animal from resting his foot 
on the ground. This pain is entirely independent of the process 
of repair, and must not alarm the veterinarian. While the react- 
ing fever is absent, and there is a good appetite and no swelling 
in the region of the coronet, the progress may be considered sat- 
isfactory. 

After the cicatrization of the plantar wound made during the 
operation, the parts may retvu'n to their physiological condition, 
or nearly so ; or, on the contrary, remain in an entirely abnormal 
condition. Often, indeed, the sesamoid sheath may become obht- 
erated, the diarthrodial surface has lost its smoothness and there is 
no more shding upon it, the tendon having become united to it. The 
animal then remains lame, and cannot be utihzed except in walk- 
ing ; if coronary anchylosis, ringbones are detected, and the appli- 
cation of firing is indicated. Sometimes neurotomy gives excellent 
results. 



640 operations on the foot. 

Contracted Heels — Hoof Bound. 

Synonym: Zwanghuff, German; Encasleture, French; Incas- 
tellatura, Italian; JEncatenadura, Spanish. 

This name has been given to a defect of the horse's foot, by 
which it becomes characterized by its general narrowness, more 
marked, hoM^ever, in the posterior than the anterior part. It is 
especially marked by the diminution of the lateral diameter of the 
horny box, the deformity consisting in a greater or less contrac- 
tion of the heels and of the quarters. 

It is principally observed in the fore feet, and it is there only 
that it presents the characters we are about to describe. This is 
due to the fact that in the fore legs there is need of a certain ex- 
pansibility in the posterior part of the foot, which, especially during 
the action of locomotion, receives the weight of the body ; while 
the contraction of the hind feet gives rise only to an ordinary form 
of lameness. Sometimes one of the anterior legs only is affected; 
sometimes both, and in this latter case the alteration is usually 
greater in one foot than in the other. 

Some horses are also seen whose feet are contracted only on 
one, usually the inner side, while the other preserves its normal 
form and directions. 

Sometimes "hoof-bovmd" is only a simple deformity, without 
lameness and without serious result. But in most cases, it consti- 
tutes a very serious affection, which renders many horses useless 
and almost without value. It is of more common occuri-ence than 
is generally admitted, and gives rise to many other affections of 
the foot. Cases of lameness treated as located in the shoulder, or 
as navicular disease, are very often nothing but the result of com- 
mencing contraction of the heels. True navicular arthritis and 
hoof-bound are closely related. Whether the disease of the sesa- 
moid sheath, arising primitively, brings on the subsequent con- 
traction ; whether the contraction akeady existing gives rise to the 
alteration of structure which constitutes the disease so named, 
cannot always be determined. Hoof-bound was known in old 
times, and the oldest hippiatrics have proposed means to cure it. 
Eiders especially have studied it, because the disease is most com- 
mon in fine saddle horses, whose feet are small. It is frequent in 
Turkish and Spanish horses, and animals from the Pyrenean dis- 
tricts, but common horses are not exempt from it. 



DISEASES. 641 

H. Bouley describes two forms of the disease, the true and the 
pretended or false contraction. In the first, the hoof is very nar- 
row, sometimes even concave on its lateral face, to such an extent 
that its antero-posterior considerably exceeds its tranverse diame- 
ter; while at the same time its wall is more vertical, and the heels 
considerably higher than normal, and the foot looks like that of a 
-mnle, of which this is recognized as the normal appearance. In 
the false contraction, there is merely a diminution of the transver- 
sal diameter of the horny box in its posterior parts, the foot being 
narrow and contracted at the heels only. 

We prefer to recognize a total contraction where the whole foot 
is contracted, and is smaller than its fellow, atrophied, so to speak, 
consisting in a contraction of the quarter — when it is principally 
narrow in those quarters, the condition extending back to the 
heels — and a contraction of the heels when this is well marked 
from the quarters to the heels only. A coronary and a plantar 
contraction have also been designated, depending upon whether it 
occurs at the superior or inferior part of the foot, and there are 
cases where the contraction is intermediate, that is, in the middle 
of the foot only, while it has its normal size, both at the coronary 
band and at the plantar border. Single and complicated contrac- 
tions have also been named. It is admitted that it may be con,- 
genital, though rare; more often, however, it is developed by it- 
self, as a result of special causes. 

I. Symptoms. — The physiognominal aspect of the hoof-bound 
foot is characteristic, and it is by this that we shall begin the symji- 
tomatology of the disease. When the disease is total, the com- 
plete general dimensions of the foot are observed to be smaller 
than would be required by the size of the animal affected ; most 
frequently the hoof has an oval form, consequent upon the antero- 
posterior diameter exceeding the lateral, which is generally dimin- 
ished. In the contraction of the quarters, the narrow condition 
of the foot is specially marked from the centre of the quarters 
back to the heel. In contraction of the heels, the diminution is 
very marked from the centre of the quarters to the end of the 
heels, so that the two sides of the waU converge toward each other 
posteriorly in following nearly a straight line, instead of the cir- 
cular appearance of the normal state, and the heels have princi- 
pally lost their round appearance, and are elongated, and even 
pointed in appearance. The wall, in the regions where the con- 



642 OPERATIONS ON THE FOOT. 

traction is more marked, that is, behind, is either perpendicular 
to the ground, or even oblique downward and inward, in such a 
way that the coronary circumference is greater than the plantar, 
and consequently it represents an inverted truncated cone. 

The opposite form of contraction, that of the coronary, is seldom 
seen, and we may ignore it. The wall is irregularly rough and 
ramy, and without its shining appearance. The heels are gener- 
ally high, nearly as high as the toe, though it is not so severely 
altered in cases where the heels only are contracted. As a con- 
sequence of the contraction of the plantar border of the wall, the 
sole seems to become folded in the direction of its antero-posterior 
axis, and it shows a much greater concavity on its internal face 
than in the normal state. This cavity is then filled by the frog, 
considerably reduced in size, thus presenting an idea of the sever- 
ity of the contraction. Most frequently it is a thin, thready body, 
flattened on its sides by the closing of the bars ; its branches, thin 
and narrow, resembling two bands so closely resting on each other 
that the lacunae which separates them is no more than a narrow 
fissure, which will scarcely admit the introduction of the thin 
blade of a knife, and from the bottom of which escapes a sero- 
purulent, gray or blackish liquid ; the lateral lacunae being also 
transformed into two narrow and deep fissures, filled with the 
same fluid. The bars, generally high, assume a direction perpen- 
dicular to the ground, instead of being obUque, as in the normal 
state, from the centre of the foot toward its cii'cumference. 

In all the regions of the foot, but especially at the wall, the 
horn is so dry and hard that sharp instruments cannot cut its cor- 
tical covering, while it is at the same time brittle, and hence nu- 
merous superficial fissures appear at the quarters, and the outside 
and inside toes, the frog itself being hollowed by fissures upon its 
body and branches. Sometimes it happens that the bars show 
deep fissures, running from above downward, to the extremity of 
the lateral lacunse, which are thus continued by a crack of the 
heel up to the skin of the coronary band. There is often a sepa- 
ration of the wall and the sole, the formation of what has been 
called a double wall, or false quarter. Quarter cracks are com- 
monly met with it. Corns are frequently seen in connection with it. 

Whatever may be the form of the contraction, it is generally 
accompanied by pain, manifested by change of position while at 
rest and by lameness when in action. 



DISEASES. 643 

If only on one side, the affected leg is carried forward, and 
thus relieved from the too painful pressure which would take 
place if it remained in a vertical du'ection vmder the center of 
gravity. "When both feet are diseased, the horse is constantly 
moving and balancing himself, pointing the legs alternately, and 
sometimes stretching both legs forward, as in laminitis, but always 
moving, so as to push his bedding under him and away from his 
fore feet. 

If the pain is slight, there is only a stiff gait, and the animal 
hesitates and stumbles easily. But if the disease is advanced the 
lameness is great and the animal is very groggy in his gait. He 
fears to rest on his heels, which, without being a peculiar charac- 
teristic, is a symptom which present, however, a particularly notice- 
able condition. While there is hesitation in the action of resting, 
there is difficulty in that of the shoulder. This is principally 
observable when the disease affects both feet. The shoulders 
then seem to be fixed to the trunk, and their motion forward is 
very limited. The symptoms are mostly more marked when the 
animal leaves the stable. It may then happen that the pain tem- 
porarily losing somewhat of its intensity as the horse is moved, 
the shoulders become more free, the Hberty of action returns, 
and once warmed up, the animal may offer a totally different ap- 
pearance from that when first leaving the stable. But as soon as 
they become rested, the pain returns as severely as before, if not 
more so, and with it the same exhibitions of symptoms. 

The examination of the unshod foot while it is warm, shows 
the extreme sensibHty of the heels. The foot being pared, gen- 
erally one may observe, in the region where the contraction is 
most marked, yellowish or reddish discolorations, evidences of 
the brvdses in the Uving parts, as weU as of the serous or bloody 
exudations which have taken place on their siirfaces. These indi- 
cations are especially abundant on the level of the sole and wall. 
If the contraction is old, there is at that point a purulent mass 
which, when removed, leaves a ca^dty which sometimes extends 
upward under the quarters. It is a separation of the wall, of two 
or three centimeters in depth. 

An important observation for hoof-bound, and which assists in 
its recognition, is the increased wear upon the shoes at the toe, 
which takes place not only when animals are working, but also 
while idle in the stable, as the result of pointing and scraping the 



644 OPEKATIONS ON THE FOOT. 

stable floor. The horse which has both feet diseased in constantly 
in motion, to such an extent that his shoes are entirely worn in a 
few days. 

At times the pain is so great that it gives rise to general symp- 
toms ; the animal becomes anxious, loses his appetite, refuses his 
food, lies down most of the time, and rises only with difficulty. 

II. Complications. — We have already seen that quarter cracks 
and dry corns are common affections of contracted feet. Exos- 
tosis of the phalangeal region is also commonly met in such feet, 
especially side-bones. Knuckling, and diseases of the tendons 
and of their sheaths are also often caused by contractions of the 
feet. The rest of the foot on its whole surface is thus perverted 
and the tendons become retracted, painful and swollen. 

Navicular disease is so often met with in company with con- 
tracted feet, that one disease is frequently mistaken for the other. 
Laminitis has been said to be also one of the complications ; if 
so, it is at least quite rare in its occurrence. 

Tetanus has sometimes been observed among its associations, 
and Hartmann attributes the development of so-called idiopathic 
cases of that disease to this condition of the feet. 

The emaciation of the affected leg is a complication seen also, 
with other forms of lameness. 

III. Pathological Anatomy. — We have indicated the external 
changes of the hoof. The tissues that have been long enclosed in 
the contracted foot become atrophied ; molecular changes do not 
take place as in the normal state ; they become changed in aspect, 
composition and properties ; they become denser and more com- 
pact, and are no more able to fulfill, to the same extent, their 
physiological functions. 

The plantar cushion is so completely pressed upon itself that 
the stratified structure of its fibrous layers can scarcely be dis- 
tinguished, and the presence in the interstices of the yellow fibrous 
substance is with difficulty observed. It forms only a homogene- 
ous mass, whitish in color, resisting in consistency, and lardac- 
eous in aspect The dilated bulbs which are above the cushion 
are also considerably diminished in size, and present, when cut 
through, a uniform white color, its composing substance being 
reduced to a single inelastic mass. 

The ungueal phalanx becomes deformed by degrees, loses its 
circular shape and becomes of an elongated oval form. Its lateral 



DISEASES. 645 

faces assume a perpendicular direction; its structui-e is modified; 
its substance becomes more compact, and the small vascular open- 
ings are obliterated, while the largest are increased in size. The 
work of obHteration is specially observable at the patilobe emi- 
nences, which appear to be crushed. The lateral cartilages are 
also much compressed, condensed and modified in their struc- 
ture. 

The navicular bone is also compressed, the sheath and its sup- 
port not allowing the easy play of the tendons, and it is in this 
way that navicular disease may follow hoof-bound. But there 
is a specially noticeable modification in the keratogenous appara- 
tus, which, as a consequence of the arterial obliterations, fails to 
receive freely and actively the necessary amount of blood. The 
homy secretion proper to the podophyllous tissue, the white or 
soft horn, is reduced; the podophyllous tissue itself is atro- 
phied ; its lamellse are less prominent and their separations are 
diminished in dejjth ; the adherence of the podophyllous or kera- 
phyllous tissues still exists where the circulation of the blood is 
not inteiTupted, but beyond, they are easily separated and often 
present deep excavations toward the sole. 

If hoof-bound advances slowly, the same atrophy of the sub- 
horny tissues takes place. Then, however, it proceeds by degrees, 
the tissues accommodating themselves in size to the gradually 
diminishing dimensions of the ca^dty where they are contained, 
and there is an equal proportion between the size of the hoof and 
the volume of the tissues enclosed in it. These being less com- 
pressed, there is less pain. In this manner an excessive contrac- 
tion of the heels may sometimes exist without marked lameness. 

IV. Prognosis. — This is the more serious as the disease is 
more developed. Total hoof-bound if excessively tenacious, and 
resists the best curative measures, though if there is only a slight 
contraction at the heels, it is generally amenable to judicious 
treatment. The duration of the disease is an important factor in 
the question of the success of the treatment, as the condition of 
the OS coronse, os pedis, na^acular bone, sesamoid sheath, plantar 
cushion and the atrophy of the keratogenous membranes have all 
to be taken into consideration. 

The age of the diseased animal and any existing compUcations 
are, of course, circumstances which influence the prognosis in an 
imjDortant degree. 



646 OPERATIONS ON THE FOOT. 

V. Etiology. — Hoof-bound, says H. Bouley, is not a simple 
fact, produced by a unique cause acting always in the same man- 
ner : it is, on the contrary, a very complex one, to the production 
of which a great number of causes of various character and inten- 
sity contribute with simultaneous or successive effects. 

The hygrometic condition of the horny substance is a principal 
feature in the etiology of the disease. It is when the hoof loses 
by evajioration the moisture which it should contain that it con- 
tracts as all organic substances do, and its flexibility returns when 
by sufficiently long immersion in a liquid, the moisture it has lost 
is recovered. Observation proves that this disease often finds the 
conditions of its presence in circumstances which induce dryness 
in the part. In such cases the foot has the property of retracting, 
to an extreme degree, especially toward its posterior extremity, 
where the frog is situated, constituted as it is of a softer and 
more depressible substance than that of the wall. The same phe- 
nomena takes place in the living structure that is observed upon 
the hoofs of dead feet ; a phenomenon which cannot even be pre- 
vented by filling their cavity with plaster. During life the hoof is 
constantly permeated by a current of fluids which penetrate it 
from its depth to the surface. It is the serous food that the hoof 
is continually absorbing by the hygroscopic properties common in 
living tissues, which counterbalance the tendency of the foot to 
retract upon itself and keep it in the dimensions required for the 
perfect "deception of the parts it covers. So long as the equilib- 
rium is preserved between the loss of this fluid by evaporation 
and its renewal through the perspiration of the keratogenous 
apjDaratus, the hoof preserves its physiological form ; but if this 
equilibrium is destroyed by an excess of the loss, then the condi- 
tion occurs for the retraction of the hoof and the infliction upon 
the parts underneath of an excessive and painful jpressure. 

This explains why, as proved by observation, lameness in 
general and that of contracted heels especially, is more frequent 
in warm than in moist seasons. Long standing in the stable is 
also an efficient producing cause. The feet become dry upon a 
constantly dry bedding, and here also the influence of inaction 
must be taken into account. The disease is commonly found in 
stabulation, but seldom when the animal is in pasture ; and when 
it has existed it often disappears in the latter circumstances. 

The alternation of dampness and dryness also influences per- 



DISEASES. 647 

haps more the genesis of the disease than dryness alone. A foot 
too much impregnated with dampness, which is afterward left to 
the ail', becomes harder than a normal one placed in the same con- 
ditions. It retracts easier, also. It is probable that the water, in 
softening the superficial layers of the wall, also renders the evap- 
oration of the Hquids of its deep parts more active. In the ordi- 
nary condition of the foot, the evaporation is diminished by the 
impermeability of the external hoof, which it owes to its density ; 
but where this hoof is softened by maceration, its fibres, partly 
disintegrated by the dissolution of the glutinous substance which 
keeps them as a compact mass, allow the air to penetrate in their 
interspaces ; air which diies them to a certain depth ; hence a 
groportionate movement of retraction of the entire hoof upon 
itself. This evil efi"ect of an excess of moisture explains how it is 
that poultices or other moist applications which horse attendants 
abuse so frequently, may give rise to resvdts entirely opposite to 
the one in view, and why the hoof becomes dry and brittle, if not 
contracted. These topical appUcations take off from the cortical 
layer of the foot its protecting varnish, and expose it to lose its 
water of growth. 

Some of the practices in shoeing contribute also to the dessi- 
cation of the hoof ; such is principally that which consists in rasp- 
ing the wall from the coronary band to the plantar border ; as 
also the too long continued contact of a hot shoe with the foot. 

Shoeing itself promotes the same result, as, protected by a 
shoe," the foot no longer wears normally and grows beyond nor- 
mal limits. The mass of hoof which, in the process of growth, 
has gone beyond the inferior limits of the podophyllous fissures, is 
no longer in contact with the living parts beneath, and they cease 
to be impregnated by the fluids which are thus constantly allowed 
to evaporate. It then dries up by evaporation and become hard, 
and retracts upon itself in such a manner that the circumference 
of the foot in the lateral diameter diminishes more or less, espec- 
ally posteriorly, and thus forces the incvirvations of the sole and 
of the bars (H. Bouley). If a horse remains shod for several 
months without having his feet trimmed and pared by the black- 
smith, these are seen contracting by degrees, as they increase in 
length, and soon assume the aspect of hoof-bound. 

But these are not the only effects of shoeing in the etiology of 
contraction. On the contrary, this practice is the most common 



648 OPERATIONS ON THE FOOT. 

cause of this lesion of the hoof if not practiced with the intelli- 
gence it requires. We have said, in speaking of corns, that they 
were proofs of bad shoeing. The same might be said of the con- 
traction. Moreover, corns generally indicate great errors in shoe- 
ing, while hoof-bound demonstrates the ignorance of the physiology 
of the hoof, which in action must enjoy the necessary elasticity to 
relieve the contact with the weight of the body upon the ground. 
No doubt the theory of Bracy Clark exaggerates the degree of 
elasticity in admitting a great power of dilatation of the hoof, but 
it is an opposite excess to deny it entirely. The dilatation of the 
hoof, though hmited, is evident at the heels; especially on feet 
which have never been shod (Merche). There is especially in the 
inside of the foot, in the soft and supple parts, a certain compres- 
sibility of the hoof, which is often overlooked, and which is inter- 
fered with by a too narrow or vmmethodical shoeing. 

The external dilatation of the hoof is comparatively Umited, 
but on the inside of the hoof there is, in the posterior part of the 
foot (especially in the fore feet) a movement downward and out- 
ward of the OS pedis, for whether the normal elasticity of the hoof 
is necessary, either by the physical and physiological constitution 
or the arrangement of the constituent parts of the hoof. Quite 
often, then, shoeing, especially if too tight, resists the internal 
pressure. Even admitting that the dilatation of the heel is nor- 
mal, shoeing which wordd prevent it, would always produce, at 
the time of rest, a pressure upon the hoof which would Umit the 
compressibility of the deep, soft tissues. The frog, especially, 
formed of a softer horn, and placed under the plantar cushion, 
must receive this gradual pressure, which diminishes by degrees 
as the hoof becomes harder, and is reduced considerably as it 
reaches the external horny layers. 

The errors committed in shoeing, and which predispose to 
hoof-bound, vary. The first is in the manner in which the foot is 
pared ; too often the heels are lowered to excess, while the toe is 
allowed to remain too long ; too often, again, the bars are hollowed 
too deeply, thinned too much, as weU as the frog. The wall then 
tends to retreat, as it is no longer protected behind. In reducing 
the height of the heels, in opening them, the tendency to contrac- 
tion is increased ; the thinned hoof dries up, the lowered heels 
lose their strength, and the bars are unable to perform their 
functions. 



DISEASES. , 649 

A vicious adjustment also contributes to contraction. Wlien the 
shoe is so prepared that its upj^er face is concave, and its branches 
form a plane inclined from without inward, and when this face ' 
extends back to the heels, there is a circular pressure produced 
upon the inferior border of the wall. This is a case in which the 
foot has a tendency to drop, pressed in as it also is by the weight 
of the body as the foot rests on the ground. 

Another wrong practice is to place the nails too near the heels. 
The fixing of the shoe on the foot tends always to produce con- 
traction, as Bracy Clark observed ; it esjjecially prevents the wide- 
ening of the hoof, as remarked by Eodet and Coleman. But this 
e£fect of the nails is well marked at the heels, where they prevent 
the dilatation of that part of the foot. 

These effects of shoeing are to be observed so much the more 
rapidly and seriously when the hoof is thicker, denser, and of a 
finer structure, as it is observed in small feet. In these feet, the 
hoof grows more rapidly, and is on this account more ready to 
contract. Let us now consider that this e£fect of shoeing is per- 
manent, and that to the effect of a first shoeing comes to be added 
that of a second, of a third, and so on, and we can readily under- 
stand how truly the great number of contracted heels one may 
meet with can be attributed to erroneous shoeing. 

Inaction is also an important cause, as, says Turner, the horse 
is by nature destined to be always in motion ; it is a condition of 
its health, and it is on accoiint of this condition that in the state 
of nature he is free from contracted heels. It is, on the contrary, 
because the domesticated horse is confined within a stall for hours 
and days, that his feet become contracted. We have seen colts 
raised without exercise, whose feet were contracted before they 
were shod. 

Contraction of the heels is often the result of other diseases of 
the hoof, and of other lameness. It is commonly associated with 
corns, navicular disease, punctured wounds of the plantar region, 
accompanied with long sensitiveness of the posterior parts of the 
foot, after-diseases of the frog, thrushes, side bones, phalangeal 
articular diseases; in fact, after all affections of long standing, 
even if they have theu' seat in the upper segment of the frog. 

Finally, heredity has been named as one of the causes. This 
cannot be denied as to some breeds, principally of meridional 
climates, as a consequence of the organization of their feet, wliich 



650 OPERATIONS ON THE FOOT. 

are usually small. The proposition has, however, we believe, 
been exaggerated. This is proved by the Arabian horse, which, 
though accused of the vicious confirmation from heredity, has, 
according to Vallon, Crompton, and others, the most admirable 
comformation of his feet, when it has not been shod. It is broad, 
with good heels, neither too high nor too low, well open, well 
prominent, wide frog, the external wall being strong and well 
developed. In the horses of Caramania, Anatolia, Syria, and those 
of the Arabs, which are constantly in the desert, from Bagdad 
and Bassaro to the Gulf of Persia, the foot is handsomely made, 
and free from all contractions when it has been exempted from 
shoeing. 

VI. Treatment. — Prophylaxy plays an important part in the 
treatment of this disease. It is easier and especially more rational, 
to j)revent than to cure it when once established. 

One of the first indications is to prevent the drying of the hoof, 
to efi'ect which baths and poultices have been commonly used — 
the latter formed of cow manure, of clay, etc. — or by the applica- 
tion of greasy substances, in order to diminish the evaporation of 
the water of the hoof. Some practitioners are accustomed to use 
tar and various hoof ointments. The number of preparations 
brought into use is considerable, and in respect to some of these, 
the secret of which has been kept by the inventors, the effects 
have been entirely different, and the hoof, instead of preserving 
its natural good condition, has been altered in its qualities. " It 
is not with ointment," says Hartman, "that the hoof injured by 
the blacksmith can be repaired. It is by good shoeing, and never 
otherwise. The workman, to excuse himself, attributes to the 
quahty of the hoof the origin of the mischief he has done." Hoof 
ointment never gives to the hoof its natural polish, but many oint- 
ments, by becoming rancid, take off that which the blacksmith has 
left. The irritating ingredients which compose them sometimes 
produce the same results. This does not mean that a reasonable 
application of ointment is not necessary ; but to act favorably it 
is essential that one coat should be carefully removed before 
the application of another. Otherwise, the new will fail of its 
proper effect, and, on the contrary, the old coat, by its alteration, 
will give rise to a deterioration of the hoof, especially in affecting 
the substance which unites the homy elements, and would reduce 
it to fine powder. And, again, ordinarily it is only the wall which 



DISEASES. 651 

is greased, the lioof of the sole and of the frog being left without, 
though they may be in equal need of it. The best hoof ointment 
is made of lard, a small quantity of wax or turpentine, sometimes 
mixed with tar. Glycerine is very useful, to give the hoof supple- 
ness when it has become hard ; it is appUed by friction, after the 
foot has been well washed and dried. In the majority of cases 
poultices are preferable to mucilaginous baths. 

Greasing is necessary for horses which are much exposed to 
dampness, and is as good for the sole and frog, as for the waU. 
It is appHcable, also, to feet which have to stand on dry bedding. 
Feet, which, on account of diseased conditions, require to be fre- 
quently soaked or poulticed, ought also to be greased. Bedding 
of fine sand and of sawdust has been recommended. It is well, 
also, to place horses upon marshy lands. All these measures may 
be advantageous if the feet are properly shod. 

Good shoeing is the essential prophylaxy of hoof-bound ; we 
must avoid all improper practices likely to promote desiccation 
and contraction of the foot, such as abuse of the rasp ; too long 
application of the heated shoe when fitting ifc to the foot ; the 
lowering of the heels ; the excessive paring of the frog or of the 
bars ; the bad fitting of the shoe ; useless calks ; too many nails 
in the quarter or near the heels — all these errors must be carefully 
avoided. The foot, moreover, must not be allowed to grow too 
long. The shoeing should be renewed at least monthly, even if 
the shoe is not worn. And lastly, the horse must not be allowed 
too long pei'iods of inactivity. 

It has been proj)osed to abolish the custom of shoeing, but in 
the present conditions and modes of using the horse this is im- 
possible. The feet, deprived of their accustomed protection, would 
soon become painful, and only by keeping the animal in the coun- 
try could the feet be sufiered to remain unshod. 

Several modes of shoeing have been invented to prevent con- 
tractions in feet which are predisposed to them. Some are un- 
doubtedly beneficial, but they must be used as an ordinary shoe- 
ing, and not reserved until the access of the disease. Good 
ordinary shoeing is often all that is required, but no doubt better 
and quicker results will be obtained by the shoe with short branches, 
with the flat shoe, or with the Charlier shoe. 

The half shoe, the shoe unth short branches {fer a croissant), 
originally recommended by Cesar Fiaschi, then by Solleysel, La- 



652 



OPERATIONS ON THE FOOT. 




Pig. 498.— Short-toranctied Shoe. 



fosse, Sr., and Crompton, is 
an ordinary shoe, made light, 
with very short branches 
(Figure 498), which when 
put on jorotects the toe, the 
marnmse (outside or inside 
toe), and the anterior parts 
of the quarter in such a man- 
ner that the parts posterior 
to these remain uncovered, 
and rest directly on the 
ground. Thus shod, the 
shoe is almost in its natural 
condition; it rests on the 
ground by its posterier part, 
and the heels are made to 
contribute to the movement 
of expansion of the elastic 
parts of the foot. This shoe, then, has real advantages, if the 
posterior part of the foot is yet normal, but if the heels are low 
and the frog atrophied, it ceases to be of service. 

The flat shoe, or the shoe icith hase {fer a siege), first recom- 
mended by Osmer, Morcroft, and more recently by Miles, Ein- 
siedel and Hartmann, is the style generally adopted at the pre- 
sent time in Saxony, and in various parts of Germany, as well as 
in England. In France it has found its way through the benefits 
observed by a few veterinarians. It is a shoe almost equal in 
thickness to its width, square, so to speak, but as light as possi- 
ble ; the internal border of the foot surface being hollowed or 
dished in order not to come in contact with the sole, while the 
part which rests on the j^lantar border of the wall is perfectly flat 
and horizontal. The heel portion is rounded, and covers mostly 
the heels of the foot where the borders of the shoe become jjer- 
fectly adapted to the borders of the wall, to the remotest part of 
the heels, and preserves the same contour until it reaches the frog. 
The shoe nowhere projects beyond the border of the wall ; it is 
only toward the toe that it is slightly raised and has a small clip. 
The groove of the English shoe renders its application better 
than the peculiar nail holes of the French. Five or six nails are 
usually sufficient. This shoe allows the dilatation of the foot in 



DISEASES. 



653 



all its limits, and while jDrotecting the heels, does not predispose 
to their contraction. For its appHcation, the plantar border only- 
needs paring. That of the sole, the frog and the bars mvist be 

carefully avoided. 

For the shoeing of Charlier, or 'peri-plantar (Figs. 499 and 
500) the part of the hoof which is most exposed is protected. It 




Fig. 499.— Foot prepared for Charlier Shoe. Fig. 500.— Foot Shod; Charlier's Method. 



preserves entirely all the other parts of the plantar surface in such 
a way that, as in the conditions of nature, it is only by the fact of 
the wearing of the shoe that the excess of hoof is gradually re- 
moved. The foot shod by this process is provided at its inferior 
border with a metallic bar, often greater in thickness than in 
width, lodged in a groove made exclusively in the wall. This bar 
adapts itself in its internal circumference to the contour of the 
sole, which projects beyond the border of the groove, because all 
its thickness has been preserved as well as that of the frog and of 
the bars. In this way the rest of the foot receives its adjustment 
from the shoe itself, and by the regions of the plantar surface 
which it surrounds. This result does not, however, take place 
immediately, or when the foot is recently shod ; but by degrees, 
and as the shoe wears out, the time arrives when the horse walks 
both on his shoe and the sole of his foot. Owing to the general 
equahzation of the friction any partial wear is thus diminished, 



654 OPEBATIONS ON THE FOOT. 

and the important result is secured of reducing the weight of the 
shoe without the necessity of too frequent renewals, experience 
having proved that for the fore-feet it is quite as durable as the 
ordinary shoe of twice its weight, but which from the manner in 
which it is applied suffers, unaided, the effects of the pressure 
and friction (H. Bouley). As in the action of paring the foot only 
the projecting portions of the wall at the inferior border are re- 
moved, the preserved parts of the plantar region resist the move- 
ment of retraction, and thus prevent its occurrence in a transverse 
direction. Agaui, as the thickness of the CharUer shoe is greater 
than its width, it possesses a certain elasticity and adapts itself to 
the successive movements of the dilatation and contraction of the 
horny box, however limited they may be. 

We may now refer to some special modes of shoeing, recom- 
mended as preventive of contracted heels, but which seem to us 
to possess inferior advantage to the preceding. We first find the 
unilateral shoe of Turner, which, according to that veterinarian, 
relieves the foot from pressure upon the heels by placing the nail 
holes on the toe and the external branch only. Turner recom- 
mends also the conservation of the frog and that of the bars, and 
it is probably to this that the success he has obtained by that 
mode of shoeing is due. 

Coleman recommended a shoe very thick at the toe and thin 
at the heels, the toe being three times as thick as the heels. This 
veterinarian thought that by this shoe the animal was obliged to 
rest on his frog ; at the same time the nails were driven in the 
toe princijDally, so as to allow the dilatation of the heels. This 
shoe has no real advantages, and predisposes to corns. 

The bar shoe is of some utility when the frog is well developed, 
by placing on that part the jjressure of the foot, and leaving the 
heels free. But it often fails in contracted heels, because in apply- 
ing it these parts require to be pared down, in order to increase 
the prominence of the frog, and a condition is thus j)roduced 
which does not exist in contracted feet. The same may be said of 
the Charlier bar shoe. The objections stated and the reasons 
suggested are true of all the various shoes designed to adjust the 
frog pressure. 

The hinge-shoe or articulated (Figs. 501 and 502) of Bracy 
Clark and Vatel, and the half-shoe of Sempastous, of Peillard, 
also possess but a doubtful utility. Practice has not confirmed 



DISEASES. 655 




Fig. 502.— Hinged Shoe. Fig. 502.— Articulated Shoe. 



the hopes of their inventors. They are difficult to make, easily 
injured, and of small solidity, and their advantages are whoUy of 
the problematic order. 

Mayer has recommended a shoe whose internal border is 
thicker than the external, in such a way that the plane of the 
plantar surface of the shoe shall be inclined outward, and instead 
of the concavity of the ordinary shoe, where the foot is pressed 
when in position of rest, there is a convexity which promotes and 
even increases the dilatation of the foot. This mode of shoeing 
has for its inconvenience the exposiu'e of the sole to contusions. 
It supposes an extensive expansion of the foot which is not natu- 
ral ; the horizontal plane is amply sufficient in ordinary circum- 
stances. We have, however, used it advantageously in preventing 
the pressure of the sole against the shoe by means of a sheet of 
gutta-percha. We have used it in almost complete contraction, 
and we think we have noticed, with Hartmann, that the dilatation 
once started by a mechanical means, not too severely apphed, 
nature continues it, with the assistance of that style of shoe. In- 
stead of giving that special shape of the shoe in its entire length, 
it has been proposed to have it only at the branches ; each heel 
presenting at its internal border a thickness double, or even treble, 
that of the external, by which the shoe is inclined outward by its 
plantar and becomes horizontal by the ground face. It is flat at 
the toe and the quarters, and is the shoe with slippers of de la 
Broue (Fig. 503), of SoUeysel, and that Vatrin has used in pro- 
posing to have the internal half of the width of the shoe inclined 
(Fig. 504). It thus resembles the shoe genete or with ears, of 



656 



OPEKATIONS ON THE FOOT. 




Pig. 503.— Shoe of de la Broue, 



Fig. 504.— Vatrin's Shoe. 

whicli we shall speak hereafter. This shoe is only indicated when 
the heels are already contracted ; they have no indication as pro- 
phylastic shoeing. 

The shoe with slippers is indeed a shoe which in some cases 
may cure contraction. " If the results obtained have not been 
very satisfactory," says Defays, " this depends not upon the shoe, 
but arises from the defective manner in which the foot was pared. 
To be efficacious in that shoeing the heels must be left alone, and 
the sole and the bars must be well thinned. It is true that in this 
way the foot is in the most favorable condition for contraction, 
but the circulation is rendered easier in the tissues underneath, 
and the effects of the thinning of the hoof are diminished by the 
resistance opposed to contraction by the inclined planes of the 
branches of the slipper. The same may be said of the shoe of 
de Belleville, also recommended by Solleysel, and for whose appU- 
cations the foot has to be carefully pared. We feel assured of the 
propriety of recommending the use of the inclined plane of the 
branches of the shoe with the presence of a smaU cHp on the 
inner borders of the heels, such as proposed by Vatrin. 

Attempts have been made to dilate the contracted foot and to 
cause its return to its normal dimensions by mechanical means. 
The shoe with ears (Fig. 505) has been devised for this purpose. 
This is a shoe provided on the inner border of each heel with 



DISEASES. 



657 



an oblique, blunt, sometimes perpendicular clip, resting upon the 
bars, which have been previously hollowed out for its reception, 
the design of which is to resist the return of the hoof which has 
been dilated, to its former contracted condition. Ruinien had 
spoken of this shoe as early as 1618. It was put on, after the 
dilatation of the hoof with the farrier's nippers, apphed on each 




FiG. 505.— Shoe with Ears. 



Fig. 506. — Jarrier Spreader. 



side of the quarter, the sole being entirely removed. In our days 
this operation of removing the sole is considered useless, and in- 
stead of the nippers of the farrier, dilators are used, under the 
name of spreaders (desencasteleur). The oldest known form is 
that of Jarrier (Fig. 506). This is composed of two curved 
branches, 11 centimetres in length, articulated at one of their ex- 
tremities hke the ordinary compass, at which point there is a 
screw of peculiar form by which the branches are closed or opened 
at will, the other extremity having a strong claw projecting out- 
ward. These claws are apphed inside of the bars, toward the 
heels, which are previously thinned out, and by manipulating the 
screw the hoof is dilated to the extent desired. The shoe is then 
used like an ordinary one, both heels being armed with a chp on 
the internal border, the cUps resting on the heels of the foot, 
which have been first opened with the drawing knife. This mode 
of treatment proved successful with Lafosse and others who ex- 
perimented with it at the Saumur school. Under various experi- 
ments, the desencasteleur has changed its form. Thus, Lafosse 
has arranged the two branches to run separately upon a transversal 



658 



OPEKATIONS ON THE FOOT. 




Fig. 507— Lafosse Desencasteleur. 



rod like an ordinary vice, in which form the branches are shorter, 
and more power is obtained (Fig. 507). There are many other 
improvements which we cannot mention for lack of space. 

Instead of applying the dilatation upon the hoof, and after- 
ward using a shoe which is closely adapted to the dilatation thus 
obtained, spreading shoes have been used. In the method of 
Jarrier, the shoe has to maintain the hoof in the condition of 
dilatation which has been accompHshed by the instruments of ex- 
pansion. It is a very delicate and difficult operation, so far as the 
proper dilatation of the foot is concerned, requiring the closest 
adaptation between the clips of the shoe and the parts of the wall 
upon which they rest. An error of a few millimetres only is suffi- 
cient to defeat the desired result ; and the shoe, moreover, must 
be taken off at each operation. To avoid this, special shoes, which 
would act also as dilators, were invented. It was not, however, a 
new idea; La Gueriniere had as early as 1733 prepared a shoe 
composed of three pieces — one median, corresponding to the toe, 
and two laterals, in connection with the quarters ; these latter are 
respectively articulated with the first, and have each three nail- 
holes. When this shoe was fixed upon a foot, whether unsoled 
or not, its branches were spread apart by a plate left in place, and 
by increasing by degrees the length of the plate, a gradual and 
increasing dilatation of the hoof was obtained. Gaspard Saunier 
improved upon this shoe by placing on the internal border of the 
branches, cranks, with a j)late placed crosswise and resting upon 
them (Figs. 508 and 508a). The objection to this shoe is that it 
cannot remain on the foot except when the animal is at rest, as 
when he is at work it soon becomes loosened ; besides which it is 
difficult to make properly. 



DISEASES. 



659 





Fig. 50&— Spreading Shoe. 



Fig. 508a.— a Better Form. 



Kolland has contrived an articulated shoe in three pieces, the 
two lateral pieces being kept apart by double steel springs, which 
press upon them from the toe on their internal border, and thus 
effect the desired dilatation. Hatin has a simpler shoe (Fig. 509). 
It is a Ught shoe, with nail-holes dis- 
tant from the heels, and provided on 
the internal border with a smaU chp, 
upon which rests a V spring, fixed by 
its point upon the toe of the shoe. 
The branches of the spring lodge ia 
the hoUows of the sole and of the frog, 
and press upon the shoe, and thus pro- 
duce a slow dilatation. Steinhoff has 
also invented a shoe with springs. It 
has recently been proposed to obtain 
the dilatation by means of a strong 
sole of cautchouc, placed between the 
shoe and the foot, leaving the frog full; 
very thin where it rests upon the shoe and the foot, and becoming 
thicker toward the inner border of the shoe, which it overlaps. 
First it rests in the groove of the bars, and then portrudes upon 
the flat of the shoe, and bears on the ground at the time of rest. 
This elastic mass, compressed at the moment of contact, slightly 
dilates the shoe, which is articulated, or, what is better, very nar- 
row at the toe, and square ; the heels, also, are thus slowly and 
gradually dilated. 




Fig 509.— Hatin's Shoe. 



660 



OPERATIONS ON THE FOOT. 



Goodwin also has invented a very ingenious, but too compli- 
cated shoe, composed of three articulated pieces. From the center 
of the median piece a prolongation of iron extends to the back of 
the frog, and is of sufficient thickness to be perforated, the hole 
having a thread through which a screw is introduced, running on 
each side. The branches of the shoe have three nail-holes, and 
from the inner border of the heel rises a clip so turned as to rest 
on the origin of the bar. The mechanism of the shoe is easy to 
understand, each branch being opened by the play of the screw 
which passes through the prolongation of the median piece, one 
extremity of which rests upon this prolongation, while the other 
presses upon the inner border of the movable branch. 

The Goodwin shoe has been es- 
sentially improved by Foures (Fig. 
510). It is a bar shoe, the bar being 
thicker than the rest of the shoe, 
and wider than the ordinary bar 
shoe. The bar is notched on each 
side, and through each notch runs 
a thread or vise which holds a mov- 
able clip, which is made to rest on 
the inside of the bars, and which 
are first properly thinned out. By 
a motion of the clip through the 
thread, the heels are slowly dilated 
Fig. 510.— Foures' Sboe. by degree. This shoe, however, is 

very expensive, difficult to make, and easily put out of order. 
In all these methods of dilatation the shoe has to be made of 
several pieces, and in this condition is found a constant cause of 
weakness and of raj)id deterioration, for which reason they are 
not very practicable. It is not so with the system used by De- 
fays, Sr., by which the shoe, besides containing the essential ele- 
ments of the desired mechanical dilatation, is left entire to fulfill 
the functions of the ordinary shoe, as well. That which charac- 
terizes Defays' method, who had used it in 1829, but which was 
made known only in later years, is that the shoe itself, which, by 
its ductnity in action, becomes the agent of the dilatation of the 
hoof, becomes also, by its natural tenacity, the obstacle to the 
return of the foot to its former contracted condition, when once 
it has yielded to the outward motion which it has acquired. De- 




DISEASKS. 661 

fays uses an ordinary shoe, thick and narrow, and then further 
narrowed at the toe, if it is to be used on a foot regularly con- 
tracted. When it is thus afiected, at five or six centimetres of the 
heels if the contraction exists at the quarters, at the end of each 
branch. This shoe carries on the inside border a strong, resisting 
clip, made at right angles, to rest on the internal border of the 
wall of the heels. The shoe is flat, grooved, like an English shoe, 
with nail-holes slightly turned inward ; the last nail-hole made as 
far as possible from the heels. It is made of the best quality of 
iron, in order to resist, when cold, the greatest amount of forced 
spreading by the dilator ; it is the ex2)answe slipper of Defay's 
{pantoKjle expansive). 

The foot upon which this slipper is to be fixed must have both 
heels pared evenly, the sole and the bai's pared down to a spring, 
and the hoof round the frog, on each side, thinned down as much 
as can be borne. Then, the shoe, flattened and without cu.rvature 
on its faces — resting, therefore, on a strictly horizontal plane — is 
put on the foot in such a manner that the cHp of the heels rests 
against the internal face of the quarters. This done, the space 
between the two heels is measured with a compass, and then the 
dilator is appHed (Fig. 511). This instrument represents a true 
vice, with jaws reversed, moving from, instead of approaching 
each other. It is formed of two jaws which can be made to ap- 
proach or separate by a transverse screw put in motion by a mov- 
able lever. The degree of separation is regulated by a graduated 
rule placed horizontally, which serves also to maintain the jaws at 
the same point when separated. The two jaws being introduced 
between the heels of the shoe, the vice being held perpendicularly 
to the plantar face, the screw is slowly tui*ned until the branches 
are opened, say, eight or nine millimetres ; then at the point or 
points of the shoe which have yielded to the pressure of the in- 
strument, one or more blows are struck with a hammer on the 
outside of the branch of the shoe, to loosen the instrument, until 
it drops down, without disturbing the screw, a record being made 
of the degree of dilatation secured, upon the graduated register. 
After three or four days the same operation is repeated, the spread- 
ing being then not more than four or five miUimetres. It must 
be less than at the first, because at the beginning the less perfect 
contact between the projection of the heels of the shoe and the 
wall has allowed a considerable amount of dilatation without pro- 



662 



OPERATIONS ON THE FOOT. 




Fig. 511.— Defays' Contrary Vise. 



ducing much result. These repeated dilatations once in four days 
for a month, are assisted by the application of soft poultices in 
horses which, on account of the pain and consequent lameness, 
are kept in the stable. Others may be put to work, and receive 
poultices only when at rest, or may be turned into damp fields. 
The shoe rarely needs changing during the treatment, which lasts 
about a month. This mode of opening the heels is especially 
practicable and of easy application, and has the advantage of 
allowing the use of the horse, whose foot is as well protected as 
with the ordinary shoe. It becomes indispensable when the dis- 



DISEASES. 



663 



ease has been of long continuance, and is accompanied with much 
lameness. It is liable to but one contra-indication, and that is 
when the foot is not sufficiently strong to hold it, by reason of the 
heels having been pared down excessively. It has been tested 
for a long time, not only by the Defays, Senior and Junior, but 
by many others. H. Bouley, in France, with Hartmann and Mayer 
in Germany, recommend it as an excellent curative treatment. 
These instruments have been modified and perfected, such as those 
shown in Figs. 512 and 513. 





Fig. 512.— Defays' Improved Vise. 



Fig. 513.— Mericant's Desencasteleur. 



We must again mention the simple and light desencasteleur of 
Jovard (Fig. 514), which is as powerful as that of Defays. It is 
composed exclusively of a double vice, with opposite threads, 
opening or closing two strong claws, which are applied upon the 




Fig. 514.— Jovard Desencasteleur. 

internal borders of the branches of the shoe ; a rod of iron is in- 
troduced in the holes of the head of the vice and puts the instru- 
ment in motion. 

It may be said that on general principles it is preferable to 
treat hoof-bound by the use of dilating shoes than to resort to 
the bloody operations recommended in earher times. It is these 



664 OPEEATIONS ON THE FOOT. 

that Brognie^ recommended highly for the removal of one or two 
quarters of the wall, with an appropriate dressing. H. Bouley, 
however, believes that it would be wrong to discard these opera- 
tions entirely; he believes that there are conditions where they 
become necessary, and where they furnish better and quicker 
results than the others referred to. 

We cannot overlook the treatment recommended by Barthelemy, 
which consists in the thinning first with the rasp, then with the 
drawing knife, of the bars, in their whole length, depth and thick- 
ness; thinning them down to a spring under the pressure of the 
finger. This done, a layer of bHster is ajDpUed on the skin of the 
cuti dura and upon it, in the parts corresponding where the hoof 
has been thinned down; the apphcation to be renewed several 
times, until the lameness has subsided. This operation is followed 
by an excess of the horny secretion and a marked enlargement of 
the hoof, and gives good but slow results. Gross has often oper- 
ated in the same manner, alternating the blister with poultices. 

A modus operandi which has also been very satisfactory, 
is the one that was recently made known by Weber, and which 
consists in the division of the wall at several points, by grooves 
extending down to the keraphyllous horn, in the direction of the 
fibres of the hoof. Two or three are made, on each side, between 
the quarters and the heels, the heels at the same time being pared 
down, when a bar shoe is put on which rests on the frog, or if 
that organ is atrophied, pressure upon it is simulated by the ad- 
dition of pieces of leather. Frequently, instead of paring the 
heels down excessively, and when the frog is atrophied, we prefer 
a slipper after having pared the sole and bars to a spring. The 
method of Weber is not new. It was previously known by La- 
gueriniere, and is mentioned by Brogniez and Hurtrel d'Arboval. 
With it we may slowly but surely achieve success, and there are 
but few feet which are not reheved or cured ; but the grooves 
must be renewed from above at each shoeing. SoUeysel made 
lines of cauterization on each side of the heels, extending from 
the hair to the shoe, which, running through the hoof, softens it 
and renders it more tractable. 

We cannot at present consider the compUcations likely to be 
encountered, but must satisfy ourselves by remarking that in cases 
of false quarters, to avoid the painful pinching of the soft parts 
between the two walls, there is nothing better than to clean the 



DISEASES. 665 

place of separation thoroughly with the drawing knife, and to fill 
the space with a putty of gutta percha. 

Diseases of the Fkog. 

This part of the horse's foot is exposed to many pathological 
lesions. Some are merely accidental, and result from the intro- 
duction into its structure of nails, and other various foreign 
bodies, more or less sharp, which the animal picks up in walking 
or performing his work. We have already considered these forms 
of lesion in the article upon punctured wounds. The frog is 
often bruised, a lesion which may be followed by a complication 
which we may be allowed to consider imder the name of furvmcle 
of the frog. But besides this, some special diseases are also ob- 
served, among them one already known to us under the name of 
canker, and another which is more commonly known under that 
of thrushes. 

(A) Thrushes. — This afi'ection is often, but wrongly, considered 
as the beginning of canker, being characterized by the presence 
of a puriform secretion, blackened and very foetid, which collects 
and accumulates in the lacunae and excavations of the frog, 
whether in its middle or upon its sides. There is often an in- 
creased sensibility of the parts, which in some cases may give 
rise to veiy serious lameness, preventing the animal from stand- 
ing, and rendering the movement of walking very painful. The 
horn of the frog often becomes soft and thready, when the frog is 
called rotten, and the softness increases until it drops off by piece- 
meal. 

The causes of this affection are, first, excessive work on stony 
roads ; changes from excessive dr\Tiess to moisture ; the strong 
muds of streets, and standing in damp and dirty places, especially 
in urine and manure, as is often the case in badly kept stables. 
But there are horses whose feet are also affected with thrushes 
even when standing on a dry bedding ; those whose feet are con- 
tracted ; and again, well-bred horses with good frogs, and in which 
there is a constitutional tendency to that condition of the horny 
structui'es. 

The treatment consists in avoiding all known causes likely to 
give rise to this morbid condition of the frog. Sometimes the 
foot must be pared, and all the parts where the puriform secretion 



666 OPERATIONS ON THE FOOT 

collects exposed and thoroughly cleansed. The lacunse of the frog 
are then to be dressed with Villate's solution, ^gyptiacum oint- 
ment and sometimes only with simple drying powders, a mixture 
of subacetate of copper, burnt alum and tannin. When the paia 
is excessive, glycerine, with a little Goulard's extract or per-chloride 
of iron, is very beneficial. Dusting with calomel powder gives 
also excellent results. In some cases again, excellent results are 
obtained by poulticing. It is certain that proper shoeing must, 
in many instances, be of great advantage. 

(B) Furuncle of the Frog. — Under this name is understood 
the partial necrosis of that portion of the plantar cushion which 
is situated above the frog proper, from a bruise of that part of the 
hoof. Loiset describes it under the name of plantar jibro-chon- 
ch'itis, connecting it with quittor, which he named, lateral Jibro- 
chondritis. 

Symrptoms. — There is nearly always, and especially at the out- 
set, a severe lameness, the greater in degree as the mortification 
is more extended and more deeply situated. While standing, 
the affected leg is carried forward, resting on the toe ; the heels 
are raised, and the fetlock is half flexed. In action, the rest is 
very slight, sometimes quite absent, and occurs on the toe only. 
As the disease progresses, and the necrosed spot develops itself, 
the animal rests his foot better, and the lameness diminishes. 

Upon examination of the foot early in the history of the case, 
a small opening may ordinarily be discovered, either on the body 
of the frog, or in its branches, while at other times there is merely 
a discharge of a yellowish serous pus of a strong odor, and more 
abundant in quantity than would be expected from the size of the 
wound, while surrounding it the hoof is loose and sometimes ready 
to drop off. If the disease is several days old a mass of dead 
tissues is ordinarily found partly loose, projecting through the 
opening of the frog, which has the aspect of a whitish body, 
slightly green, soft, loose and detached among the surrounding 
tissues. When this core (bourbillon) is not "visible it may some- 
times be felt with the finger introduced through the wound in 
the frog. 

If there is no lesion of the frog the purulent fluid accumulates 
under the hoof, raising and loosening it from the velvety tissues 
to a varying extent. 

Fluctuations may be sometimes even felt under the hoof. Some- 



DISEASES. 667 

time tlie pus oozes through the lacunae of the frog, while again it 
may then appear at the heels, after making its way under the en- 
tire sole. 

Pathological Anatomy. — As we said at the beginning, the 
characteristic lesion of the frog is the gangrene of a portion of 
the fibrous structure of the jplantar cushion, when it changes its 
general appearance and becomes of livid yellow-greenish color, 
while at the same time a process of elimination takes place in the 
surrounding parts, and pus forms, separating the dead tissues 
from the healthy structure surrounding. This process of ehmina- 
tion is more active on the surface than in the deeper parts of the 
plantar cushion, to which very often this core remains attached. 
In some serious cases the disease becomes compHcated with ne- 
crosis of the plantar aponeurosis, or of the os pedis, and some- 
times of caries of the lateral cartilages, or cartilaginous quittor. 

Causes. — Furuncle of the frog always proceeds from some vio- 
lent injury through the horny envelope of the tissues it covers, 
either when the hoof has been cut through and through by a 
sharp instrument, or as the result of some simple bruise with- 
out solution of continuity, contusion, or even crushing. Any for- 
eign body likely to produce a punctured woimd of the foot may 
produce it. But in such cases as are accompanied by furuncle it 
is necessary that the wound should be more of a contused or 
bruised than of the punctured variety. Rough, angular stones 
are the most common agents of injury, being often picked up be- 
tween the shoe and the frog, and then, pressing more or less upon 
the tissues underneath, they produce the same result when they 
are located in laminae of the frog. 

A thick, voluminous frog in a foot with low heels is very much 
exposed to the class of injuries under discussion, equally with the 
frog whose horny covering has been pared too closely. 

Treatment. — The first indication, says H. Bouley, when one 
has to treat a fiu'uncle of the frog, is to thin down as much as 
possible the horn of the plantar region, and especially that of the 
frog, of the bars and the branches of the sole, in order* to avoid 
the painful pressure it would produce if its thickness should in- 
terfere with the expansion of the parts. This done, if the frog is 
already punctured, and there is an opening communicating with 
the cavity where the core (or bourbillon) exists, a free incision or 
opening must be made through the hoof and the fibrous covering 



668 OPEKATIONS ON THE FOOT. 

of the plantar cushion, and thus the escape of the pus facilitated. 
If the homy frog has remained intact, a longitudinal incision must 
also be made in order to allow the frog to discharge, and avoid 
further burrowing or Undermining of the hoof. It is bad practice 
to attempt to puU the core out with a sharp instrument. It is 
better to leave it undisturbed and wait for the natural process of 
elimination, which may, however, be hastened by the appUcation 
of a poultice. The time required for the entire separation of the 
necrosed spot varies, and as it approaches, the animal begins to 
improve in the matter of resting his foot. When it becomes en- 
tirely detached, the cavity which it occuj)ied in the j)lantar cushion 
is treated as a simple wound, with turpentine or tincture of aloes. 
However, a dressing supported by the shoe with plates is always 
advantageous, and must be frequently repeated. No great length 
of time is usually required for the entire healing of the parts, and 
the animal is soon retvirned to his work. 

In a few cases, nevertheless, the furuncle becomes compHcated 
with necrosis of the plantar cushion, disease of the os pedis, or of 
the lateral cartilages, the treatment of which must vary according 
to the nature and severity of the lesions. In these instances 
operations similar to those required in cases of deep punctured 
wounds of the foot or in cartilaginous quittor are indicated. 

Kekaphyllocele. 

This name was given by Vatel to a tumor which forms on the 
internal surface of the wall of the horse's foot, at the expense of 
the keraphyllous tissue, which becomes hypertrophied. These 
tumors are sometimes irregularly rounded, at other elongated, 
but usually rovmded and again flattened from side to side. They 
vary in size from that of a goose quill to that of the finger, and 
while in some cases they occupy the whole length of the wall from 
the coronary band to the plantar border, in others they only begin 
at one-third or one-half of the height of the wall. The difference 
in size allows a division of keraphyllocele into complete and 
incomplete. At different points the columns are roughened by 
frequent enlargements. Sometimes full and formed by a very 
compact and hard tissue, they are, however, sometimes of a fis- 
tulous character and accompanied by a blackish discharge of an 
offensive odor. The lamellae of the reticular tissue which are 
nearest to them are generally wider and thicker than in the nor- 



DISEASES. 669 

mal state. As the tumor inci-eases it compresses the lamellated 
tissue and the corresponding surface of the os pedis, injuring the 
soft parts, and resting in a groove they thus form for theii- 
development. 

The causes which give rise to their development are more 
especially cracks of the walls ; though they often follow laminitis 
or supervene upon severe operations on the wall. Vatel claims 
to have observed them after injuries on the hoof resulting from 
the hammering of the foot while bemg shod. 

The symptoms are very obscure. At first the animal is but 
slightly sore in traveling, but the lameness increases as the tumor 
enlarges in size. The region surrounding the tumor is always 
warmer and more sensitive than is natural. In many horses the 
coronet presents a swelling, well marked. In some cases the dis- 
eased quarter is depressed, and the toe seems elongated. When 
a toe or quarter crack is accompanied with severe lameness kera- 
phyllocele may generally be svispected. But when none of these 
external signs exists it is exceedingly difficult to make a positive 
diagnosis of their presence, for though the swelling of the coro- 
net, the heat and the pain of the hoof may be present, those 
symptoms may belong also to other diseases of the foot. Then 
the only means at our disposal is to pare the foot well down, 
when, at the surface of the sole, the extremity of a portion of hoof 
ordinarily harder than the normal consistency may be detected. 

The treatment consists in removing the portion of the hoof 
corresponding to the horny tumor, as in a case of toe cracks, and 
treating the wound thus made in the same manner, according to 
the indications presented. 

Laminitis. 

Synonyms : Sehe, Verschlag, JTufentzunclung, German ; Four- 
bure, Fourbature, French; Mifondimento, Italian; Aguadura, 
Spanish. 

By this name is understood the bloody congestions of the 
keratogenous apparatus of ungulated animals. The increase of 
the circulating fluid produces a swelling of the living tissues of 
the foot ; but these being enclosed in a box of so hard, resisting 
a material, a painful pressure results, which becomes especially 
common and serious in horses and other solipeds. It has also 
been observed in bovines, though it is then less frequent and 



670 OPERATIONS ON THE FOOT. 

serious. It has also been seen in sheep, in goats and in swine. 
It may, in fact, occur in all ungulated animals. Dogs, even, are 
not exempt from its attacks. 

The simple bloody congestion, more or less inflammatory, of 
the keratogenous apparatus of the horse, is sometimes called acute 
lamiiiitis and acute founder. The disease may pass off by reso- 
lution, leaving no traces of its occurrence, but more commonly 
it becomes complicated with some lesion of more important and 
serious a character, as hemorrhage, suppuration, inflammatory 
exudation, and especially of a hypersecretion of the horny sub- 
stances, in which case it becomes chronic lamiiiitis or founder; 
an affection which gives rise to alterations of a peculiar nature, 
and leads to certain changes in the form and character of the 
hoof. We do not agree to the divisions admitted by several 
authors, iato traumatic laminitis, rheuniatismal laminitis, and 
metastatic laminitis. 

I. /Si/iJijytoms. — Laminitis, in most instances, is preceded by 
certain general symptoms, such as are premonitory of the inva- 
sions of ordiuary inflammatory diseases, but of an uncertain sig- 
nificance. There is dullness, general insensibility, muscular 
tremblings, and stiffness of the loins. The respiration is accel- 
erated, the pulse febrile, the mucous membranes iajected, the 
mouth dry, the f cecal discharges dry and coated, the urine scanty; 
and perhaps anorexia is present. Kodet, who held that laminitis 
is more a secondary than primitive affection, and that it is simply 
an inflammatory angeiothenical fever which had localized itself, 
was obliged to acknowledge that this fever has nothing character- 
istic, and that it is always followed by laminitis. 

It is certain, however, that but a short time elapses — from 
several hours to one or two days — after the originating cause has 
become active, before the bloody congestion of the reticular 
tissues and the peculiar phenomena belonging to the disease 
become manifest. It is only when the capillary circulation of 
the foot has considerably increased, and when the rigidity of the 
structure prevents the swelling of the podophyUous tissue, that 
laminitis truly exists. 

Laminitis in the horse has the following principal symptoms : 
Considerable heat of the entire foot, extreme sensibility with 
intense pain, increasing rapidly, and obliging the animal to rest 
upon the sound legs, in order to relieve the affected ones; diffi- 



DISEASES. 671 

culty and uncertainty in walking- ; and sometimes a peculiar trem- 
bling of the muscles of the patellar face of the femur, and of 
those of the extensors of the fore arm, which fill the triangular 
space formed by the scapula and the humerus. The physiognomy 
always indicates intense suffering. The pulse is hard, the respi- 
ration increased, and the skin hot, and in j)laces moistened by a 
copious perspiration. These symptoms vary with the legs which 
are affected, whether the disease is located in the fore or hind 
feet exclusively, or in all ioxa' together. As M. Bouley says, it is 
a peculiarity of this affection that it may remain localized in the 
feet of one patient, either forward or behind, or may at once 
attack the four* extremities, and that it seldom attacks the limbs 
on one side only, to the exclusion of the feet of the opposite side, 
i. e., it may be laterally biped, affecting either both the fore or 
both the hind feet, but not often occurring otherwise. Some- 
times, however, the disease is more marked in one leg than in the 
other of one biped. It is generally only after some traumatic 
lesion, or other local influence, that laminitis occurs in one foot 
only. 

When laminitis affects the two anterior feet, the animal carries 
its extremities forward, and the hind feet are brought well under 
the centre of gravity. The standing of the animal is altered, the 
walking difficult and painful, and the resting of the feet on the 
ground is done with hesitation and fear. The feet are carried 
forward, because the pressiire takes place on the frog and on the 
heels ; if it should occur* as in the healthy and normal condition, 
upon the entire inferior circumference of the foot, there wovdd be 
pressure upon all the li\ing tissues, which are gorged with blood, 
tumefied and painful, and this pressure would greatly increase 
the suffering of the patient. It is, then, to relieve himself, and 
to avoid the intensity of the pain, that the animal instinctively 
changes its mode of resting on the ground. In placing the heels 
down, the weight is borne only upon a follicular, fatty tissue ; 
from there it spreads along the side of the coronet to the fetlock, 
and thus upon all the other portions of the leg, and in this way 
the foot becomes greatly relieved during the action of resting. 
If, however, the fore legs only were carried forward, the effect 
would be equivalent to lengthening the body of the animal, and 
he would be unable to carry on the action of walking. To allow 
the fore feet to be moved, it is necessary that the body be carried 



672 OPEKATIONS ON THE FOOT. 

forward by the hind legs and brought closer under the centre of 
gravity, a position which contributes also to the rehef of the 
animal while at rest. 

The more painful and diseased the feet become, the more the 
animal fears the impingement of the ground. Thus, so to speak, 
he sounds the ground before putting the foot down, and for this 
reason the walking becomes slow, stiff and difficult, and the noise 
of the contact of the foot louder than that of the healthy legs. 
Sometimes the animal proceeds only by a series of jumps, or a 
kind of rearing, while backing is especially difficult. 

The hoofs of the foundered feet give to the hand, when feeling 
them, a sensation of heat greater than that in the physiological 
condition ; a sensation which can be more readily detected by a 
comparison of the fore and hind feet simultaneously examined. 
The pains in the diseased feet are rendered more manifest, also, 
by percussion upon the hoof with the hammer, when each blow, 
however light, is followed by a motion of the animal in suddenly 
withdrawing his foot on account of the pain experienced. The 
lateral arteries of the fetlock, in the foundered legs, beat stronger 
than in health, and can be readily felt by the fingers. The feet 
cannot be raised without great effort, and when raised, the animal 
stands only with great difficulty, and makes struggling attempts 
to relieve himself and resume its natural mode of standing on 
four legs. 

When laminitis affects only the fore feet, the animal will 
sometimes remain standing for a length of time together; he may 
retain this attitude for several days, without any displacement of 
his body ; still he is observed moving swylace, from side to side, 
especially on his fore legs, relieving one foot for a moment to give 
the same comfort immediately afterward to the other. But when, 
exhausted by fatigue and pain, the foundered horse lies down, it 
is very difficult to get him on his feet again. He continues in the 
decubital position, lying mostly flat upon his side, the fore legs in 
constant motion, and soon complicates his diseased condition by 
the addition of bed sores upon the prominent parts of .his body. 

The attitude of the animal is very different when the hind feet 
are affected; then both the anterior and posterior bipeds are 
brought to each other, the feet of the hind legs being carried for- 
ward under the abdomen, so that the rest may take place upon 
the heels ; and the anterior ones are carried backward, and nearer 



DISEASES. 673 

to the centre of gravity, to assist the fiinction of the hinder ex- 
tremities in sustaining the weight of the body. In this case, the 
animal is constantly in side motion, on account of the pain he en- 
dures Walking is still more difficult, and seems to take place as 
if the animal was treading on sharp needles, as, the more the an- 
terior biped is engaged under the body, the more also those legs 
are loaded with the animal's weight, and the more difficult is their 
movement. But the anterior legs, contrary to their ordinary func- 
tion (not being adapted to the support of an overshare of the 
body) sustaining now a great part of its mass, and moreover, 
compelled to assist in the act of propulsion, necessarily and in- 
evitably become easily fatigued, and too often in their turn be- 
come likewise affected. Animals suffering with posterior laminitis 
are found occupj^ng the standing position less frequently than 
those whose fore feet are affected. Their unsteady equihbrium, 
consequent on their mode of standing, tires them more quickly, 
and compels them to lie down, and once on the ground, it is again 
more difficult to make them rise. They may do so readily with 
the fore legs, but the posterior extremities do not always respond 
to the call. 

The attitude of animals suffering with laminitis of all the four 
feet, is the same as of those which are affected in the fore feet 
only. AH four feet are carried in advance of their plumb Une, the 
anterior forward, the posterior well under the centre of gravity. 
Sometimes the horse has all his feet somewhat apart, in order to 
carry the principal part of the weight on the inner side of the 
foot. The standing posture being painful to either foot, the 
animal lies down most of the time. Locomotion is very difficult 
and staggering, and the animal can only be induced to move by 
severe punishment, and even that cruel resort sometimes fails to 
effect it. If the animal is made to walk, he does it with the great- 
est difficulty, by reason of the increase of his sufferiags, brought 
on by the displacement. His legs, stiff and trembhng, are raised 
in a convulsive manner, and brought back to the ground with the 
greatest hesitation, and upon the heels ; the constant motion of 
the Hps of the animal being well characteristic of his sufferings. 

In the ox, laminitis is more freqvient in the hind than in the 
fore feet. It is, however, more serious in the latter, the inner 
being more affected than the outer toe. The foundered ox walks 
with hesitation, and takes advantage of every opportunity to lie 



674 OPEBATIONS ON THE FOOT. 

down. "When standing, his back is arched, the feet closed to- 
gether, the hind feet resting on the heels, the fore legs on the 
points of the toes. The fever is severe, sometimes attended with 
loss of appetite and of rumination. If the disease continues long, 
the cattle will die. The abdomen is stuck up and the animal 
loses flesh very rapidly, indicating a serious condition, as the dis- 
ease is principally found in fat animals, which are obliged to 
make forced marches to be delivered at their markets. 

II. — Termination and Complications. — Well treated, laminitis 
is generally of short duration, and ends in three or four days by 
resolution. Sometimes, however, this is not accomplished until a 
later period, even toward the tenth day, though cases of this charac- 
ter are rare ; and even when resolution proceeds slowly, some lesions 
in the foot may be looked for, and chronic laminitis will probably 
result. Eesolution in acute founder is marked by the gradual 
disappearance of the local and general symptoms. In some sub- 
jects, the improvement is quite rapid from day to day, and the 
form of termination is known as delitescency. Laminitis ending 
in resolution is not usually followed by alterations in the horny 
box or the tissues which it covers. 

When the congestion which constitutes the disease terminates 
otherwise than by resolution, it is always followed by accidents of 
varying character. Some of these may have a haj)py termination, 
but, in the end, are more or less likely to be followed by a de- 
formity of the homy box, to which the name of chronic laminitis 
is given. Before entering upon this, however, let us examine the 
various complications which may follow acute founder, and study 
in succession: the hemorrhage., inflammation with exudation, 
suppuration., gangrene., consecutive arthritis, metastasis, and, 
lastly, chronic laminitis. Eesolution is most commonly met with 
in the ox. Sometimes the separation of the hoof by suppuration 
occurs, and chronic founder is not observed in that animal. It is 
seldom that seedy toe is observed. 

a. — Hemorrhage, or apoplexy of the reticular tissue, is due to 
the rupture of the excessively distended capillaries, when the ex- 
travasated blood either infiltrates into the meshes of congested 
tissue, or spreads around it, and penetrates between the podophyl- 
lous and keraphyllous lamellse, filling up the spaces at the toe, the 
mammse and the anterior parts of the quarters, the os pedis being 
pushed back by the pressure of the incompressible fluid. The 



DISEASES. 675 

pain is then very great ; the blood, continuing to separate the tis- 
sues, often oozes at the coronary band. 

If this last sign is absent, a groove may be made with a draw- 
ing-knife in the region of the toe, behind the commissure of the 
sole and of the wall. If we meet with a cavity, resvilting from 
the extravasation of the blood in the podophyllous and keraphyl- 
lous space, or if blood flows out from it, the true nature of the 
compHcation becomes at once apparent. This mode of explora- 
tion is generally difficult, as the animal in pain does not readily 
allow his feet to be raised, and as the other foot cannot sustain 
the entire weight of the body, the horse easily falls down. It is 
sometimes necessary to throw the animal in order to make this 
exploration, which very often becomes necessary if we would know 
accurately the progress of the disease. 

b. — Injiamviation, with fibrinous exudation, or pseudo-mem- 
branous formation on the surface of the podophyllous tissue. 
The transudated fibrine mixes with the hoof, secreted by the podo- 
phyllous tissue, and this matter separates that structure from 
the keraphyllous laminae, especially at the anterior part of the 
region. Again, in chronic laminitis we find this abnormal secre- 
tion pushing the os pedis forcibly backward and separating the 
toe of the bone from that of the hoof, and thus producing a pain 
still greater and more violent than that produced by the laminitis 
and the hemorrhage. These pains are often so intense that they 
give rise to an access of furious vertigo. But pains, even when 
of an exaggerated degree, indicate simply the presence of the 
exudative form of laminitis. It is not a positive sign; the foot 
must be explored at the toe, where, in the vacuum which exists 
between the horny lamellae is found, more or less abundantly, a 
citrine serosity of a slightly reddish color. Sometimes this ser- 
osity oozes between the hair and the hoof, in consequence of the 
separation of the tissues at the coronary band, and appears in the 
foim of a thin, reddish foam, about the band itself. 

c. — Suppuration between the waU and the podophyllous tis- 
sue is a complication more rare than the others, but which, how- 
ever, has been observed, especially when laminitis is traumatic. 
We have seen it appear under the sole and separate it entirely 
from the tissues underneath. In these cases, the pain is always 
very great, and the living structures are pressed beyond measure. 
Standing is impossible, and the animal continues lying down, or, 



676 OPERATIONS ON THE FOOT. 

under the influence of the pains, constantly moving from one leg 
to another, balancing himself, so to speak. There is no relief for 
him until the suppuration has shown itself between hair and hoof, 
when it oozes outward at the coronet. Relief, however, may also be 
obtained by making an opening at the toe with the drawing-knife. 
This complication often results in the entire separation and drop- 
ping off of the hoof. Cases have been observed when this acci- 
dent has taken place as early as the third day (Lafosse, Stanley). 
Gillmeyer has seen a new foot grow out entirely, but this requires 
a long time. 

d. — Gangrene of the sub-horny tissues sometimes takes place, 
though seldom, under the influence of the excessive pressure, 
especially when there is sub-horny exudation. The violent pains 
then cease suddenly; the resting becomes more soHd; the move- 
ments take place without difficulty. But at the same time, the 
physiognomy of the patient becomes anxious and contracted; the 
pulse becomes small and difficult to count ; the temperature of the 
body diminishes ; the animal has a trembling gait ; is indifferent 
to any excitement ; he is prostrated, and soon he ends by sep- 
ticEemia. The hoof then often drops off, and the sub-horny tis- 
sues are seen to be of a bluish-brown color, without consistency, 
but with a very foetid odor. 

Volpi thought that laminitis was the inflammation of the articu- 
lation of the foot ; but this arthritis, if it exists (a fact which is 
rare), is not a consecutive phenomenon, but a compHcation, The 
inflammation does not remain limited to the recticular tissue; it 
extends also, and consecutively, to the contiguous structure, 
spreads to the tendons and articular ligaments, even penetrates 
to the synovial capsules of the articulation of the third with the 
second phalanges, and may also react upon other parts of the 
organism. The anchylosis of the articulation of the foot with 
that of the coronary joint are complications somewhat frequent, 
as well as that of the ossification of the cartilages of the foot. 

e. — Metastasis has been often observed, and when accom- 
panied by intense fever have been noticed as complicated with 
serious diseases of the chest, especially of pleuro-pneumonia. At 
other times, it has been the intestines to which the metastasis has 
transferred the disease, in which case there is, in most instances, 
constipation of the bowels. Enteritis, however, is seldom ob- 
served, notwithstanding what has been said on the subject. This 



DISEASES. 677 

metastasis has also been seen toward tlie lumbar region, and this 
is much more commonly believed from the fact that there is more 
motion at the hip than at any other joint during locomotion, and 
also because the back and the loins are more or less arched. In 
fact, laminitis has been, by some, designated as an affection of the 
loins ; some have looked upon it as a rheumatism of that region. 
All these errors have originated in the peculiar motion of the ani- 
mal while walking, or of its peculiar mode of resting when stand- 
ing still. We have also observed an attack af complete myelitis 
as a complication of laminitis. 

f. — The most common complication met with in chronic lam- 
initis is an affection which we might have treated as a special sub- 
ject had we not, upon principle, considered it as a sub-inflamma- 
tory state of acute foimder of the foot. An attack of laminitis 
which has not ended by resolution in five, ten, or fifteen days at 
most, takes a character of persistency which, in most cases, ends 
in absolute incurability. To properly study chronic laminitis we 
must observe it when the alterations which characterize it are ac- 
complished. When we have completed the consideration of the 
pathological changes, we will examine the intermediate period, 
and discuss the mechanism by which these alterations take place 
in relation to the pathological anatomy. 

The first thing observed is the 
change of form in the hoof (Fig. 
515). The nail of a horse's foot 
easily recalls the form of a Chinese 
shoe (Knollhuf, of Germany). The 
hoof seems to have also lost its 
varnish and its suppleness in the 

. , T J. J.1 T Fig. 515.— Chronic Laminitis. 

points corresponding to the dis- 
eased parts. It is, besides, brittle, and seems to have lost part 
of its connection with the remaining parts of the foot, and there 
is a change in the direction of the wall, the fibres of which, 
instead of being oblique to the ground, assume an almost hori- 
zontal direction. The foot seems as if flattened from above down- 
ward, and the lines which bound its surface form a well-marked 
obtuse angle with that of the coronary region. The anterior wall 
of the foot also forms a well-marked projection forward, from 
which results a great exaggeration of the antero-posterior diame- 
ter of the nail with the transverse diameter and the ovnl form of 




678 



OPERATIONS ON THE FOOT. 



the horny box. The external surface of the wall, instead of be- 
ing smooth, as in physiological conditions, presents, on the con- 
trary, a roughened apjpearance, which results from the presence 
of circles of ridges and circular grooves, placed one above the 
other and extending from one heel to the other. A remarkable 
peculiarity is here observed in the fact that in the anterior part of 
the nail the circles are quite near each other, while, on the con- 
trary, upon the lateral parts they are separated by much wider 
grooves. "When, then, at the toe, the wall has some difficulty in 
growing downward, on account, probably, of the internal adhes- 
ions between the podophyllous and keraphyllous tissues; the 
heels, on the contrary, grow without difficulty, and thus obtaui a 
relative height superior, and sometimes even equal, to that of the 
toe. Often at the mammse and quarters of the foot contractions 
are seen, and longitudinal grooves running from the coronary 
band to the plantar surface, reminding one of the lesions usually 

met with in encastelure. 

Considered on the side of 
the inferior face, the old f ound- 
dered hoof offers four remark- 
able lesions (Fig. 516). Besides 
its oval form, a disposition al- 
together different from that of 

Fig. 516. -Chronic Laminitis, last stage. *^® normal state, the Sole is 

convex in all the anterior part 
of the plantar region, especially at the point of the frog. There 
exists at that point a transversal tumor or enlargement, projecting 
sufficiently to exceed in height the inferior border of the wall. The 
solar sheet has been pushed outward by the pressure against the 
superior face from the contents of the horny box, and the foot is 
convex. This convexity never equals the entire extent of the foot, 
the deformity ending at the boundary of the inferior border of 
the bars, beyond which and backward are found the cavities of the 
lateral lacunse of the frog, so much more elevated as the heels are 
also higher (Fig. 517). The center of this tumor or enlargement 
of the sole is often flexible under the pressure of the finger, and 
generally bleeds easily on the application of the sharp tools of the 
blacksmith. It is not rare to see the sole perforated through and 
through and showing the inferior border of the os pedis project- 
ing through the border of the bone, which then soon becomes 




DISEASES. 



679 




f e •■ It 

Fig. 517.— Foot affected with Chronic Laminitis. 

a.— Anterior extensor of the phalanges. 6.— Ordinary wall, c.— Coronary band. 
d.—PodophyUous tissue modified, e.— Morbid horny wall. /. — Seedy toe. (/.—Displaced 
and deformed OS pedis, A.— Velvety tissue. i.—Perforans tendon, j.— Navicular bone. 
a;.— PerforatuB tendon. I —Plantar cushion. 

necrosed. This is the result of the excessive displacement of the 
OS pedis and of the strong pressure upon the velvety tissue against 
the sole-tissue, which is atrophied or even destroyed (Fig. 518). 
This is an ulcerating wound, somewhat semi-lunar, secreting a 




Fig. 518.— Chronic Laminitis, with Kerapbylocele 



680 OPERATIONS ON THE FOOT. 

very ojffensive pus, with granulation and proud flesh, or even sepa- 
ration of the sole. 

Between the sole and wall the line of demarcation is no longer 
so well defined as ki the normal state. At the toe, the mammse 
and the anterior part of the quarter, there is an excavation formed 
of softer horn of bad nature, and less identified with the true 
horn of the wall and of the sole. A complete vacuity is often 
found, a cavity around the internal face of the wall at the toe and 
at the mammae of varying depth and size, but always larger at the 
inferior than at the superior end of the foot, where it gradually 
diminishes, and often contaias a dry, granular mass, resulting 
from the drying of the blood, and the dried plastic lymph, mixed 
with small, horny, pulverized masses. This cavity is formed in 
front by the healthy wall and posteriorly by a new wall due to 
the secreted hoof thrown upon the podophyllous tissue ; this is 
called seedy toe. This double wall is observed especially after 
laminitis of the hind feet ; it is more common in the donkey and 
the mule ; it is also noticed in horses with small feet, as in those 
of Oriental breeds. 

The deformities of the horny box due to chronic laminitis are 
not in aU cases identical in their character; there are degrees in 
them, and consequently they vary in their features, which varia- 
tions are due to the duration of the disease and its intensity, and 
also, according to H. Bouley, to the primitive form of the diseased 
foot. In a case of chronic f ovmder of the fore feet, one may often 
notice a difference between the deformity of the left and that of 
the right foot. The deformities may take place at various times, 
and one may find a well-marked case of seedy toe while as yet 
the wall has preserved its normal oblique direction and shown 
rudimentary ramy appearances. Again, the wall may have under- 
gone changes in its direction only at the new hoof, which grows 
from the coronary band; there is then formed between the old 
wall and the coronet a circular groove, sometimes called the digi- 
tal cavity, the deformities of the wall taking place only as it grows 
down. At times, also, instead of the groove, there is a ridge of 
horn at the coronary band, originating in the hyper-secretion of 
the horn, which grows also downward. And, again, there are 
cases where there is seedy toe and still no weU-marked alteration 
of the shape of the wall of the sole. 

Chronic laminitis is always accompanied with more or less 



DISEASES. 681 

lameness. There are cases, however, where it is missing ; for ex- 
ample, in seedy toe. Ordinarily, the foot is raised from the ground 
with a convulsive motion, as may be well observed in donkeys and 
mules, which animals rest their feet on the heels. This soreness 
diminishes with time, as the foot, assuming its new form, offers a 
wider space to the sub-ungulated tissues and presses less upon 
them, these tissues having, at the same time, become somewhat 
atrophied. In cases of hernia of the os pedis, the resting of the 
foot on the ground is almost impossible, the 'animal being afraid 
to bear his weight on the sole. The heat and the pain of the feet 
are less marked. The percussion is louder in case of seedy toe, 
while it is duller when the sj)ace between the wall and the recticu- 
lar structure is filled with hoof of new formation. This percus- 
sion is very painful in case of keraphylocele. Unless there are 
serious lesions, chronic laminitis is not accompanied with fever. 

III. Pathological Anatomy. — At the initial period of lamini- 
tis, when there is only simple congestion of the keratogenous ap- 
paratus, and especially of the podophj'Uous tissue, the sub-horny 
tissues are in a condition of sanguineous derangement, characterized 
by objective signs. WTien the hoof covering them during life is 
removed, they are found of a dark red color, in a kind of eythema. 
When pressed between the fingers, their thickness is noted to be 
increased, and they are found to be gorged with blood, an incision 
made through them allowing the escape of a large quantity of 
that fluid. 

If the laminitis exists for several days, the podophyllous tissue 
is found to be infiltrated with plastic exudations, and if there has 
been hemorrhage or apoplexy, blood is found between both the 
sensitive and insensitive laminae. In other cases there is pus, and 
in case of gangrene, the tissues are found of a livid color. 

The alterations are still more serious in cases of chronic 
founder. "^k\Tien a foot, foundered for some time, is divided by 
the saw in its antero-posterior axis by a section of all the parts, 
the thing first noticed is a change in the connection of the os 
pedis with the wall. These changes, however, exist principally at 
the toe, and extend as far as the half of the quarters, on a level 
with the lateral cartilages of the foot, while further backward they 
are not to be observed. On the side, some laminae are always 
found in their normal condition, as can be seen by a section of 
the foot made transversely. Generally, a yellowish substance, of 



682 OPERATIONS ON THE FOOT. 

horny appearance, but softer, fills up the si^ace situated between 
the walls and the keratogenous structure. This is the product of 
the exudation of the inflamed podoj)hyllous laminae, mixed with 
the horny substance which they secrete normally. These laminae 
are themselves hypertrophied, being sometimes one and two cen- 
timeters in length and exceeding by four or five times their nor- 
mal size. The keraphyllous laminae are also hypertrophied, a 
condition which is evidently due, as respects the podophyllous 
tissue, to the increase of vital activity, resulting from the inflam- 
matory condition of the tissue and to the infiltration by fibro- 
plastic exudation, resulting from the inflammation. As to the 
keraphyllous laminae, they repeat on the internal face of the wall, 
in an inverse manner, the disposition of the secreting laminae of 
the hoof between which they are formed and lodged. These, 
however, as they increase in extent, unite at their base in the 
whole of that portion which does not co-operate to their union 
with the podophyllous bands, and then forms a compact mass 
uniting most frequently with the internal face of the wall. Some- 
times this mass of yellowish hoof occupies the whole space be- 
tween the OS pedis and the wall, but, in some cases, it adheres 
only to the wall, when it forms around the keratogenous tissue, a 
new wall, also provided with keraphyllous laminae, and there is 
formed between it and the normal wall that porous, brittle mass, 
without homogeneity, which fills up the sj^ace, which constitutes 
the seedy toe. The mass thrown between the wall and the os 
pedis presses upon it ; the anterior face of the bone assumes a 
vertical direction, and the os pedis presses toward the solar arch 
on its anterior border at a point situated posterior to that where, 
in normal feet, this border rests. Notwithstanding its resting 
power, the wall gives to the effort of the mass interposed in front, 
the form of the foot changes, and then results the change to the 
oval in the contour of the foot. Under the influence of the dis- 
placement of the phalanx, not only the flattening and afterward 
the convexity of the sole and even its perforation results, but the 
plantar cushion is itself pressed down and crushed between the 
bone and the frog, which is then generally atrophied. A hoof of 
new formation is often developed between the sole and the infe- 
rior face of the phalanx, in order to prevent it from necessarily 
sinking. This increases the jjressure upon the bone and contrib- 
utes to its atrophy and sometimes to its complete disintegration. 



DISEASES. 683 

But, between the surface of the coronary band and the origin 
of the roof, whose formation is anterior to the laminitis, there 
may also be a new layer of hoof, more resisting than that which 
occupies the space between the wall and the podophyllous tissue, 
which is no more hoof mixed with the fibrinous exudation, but a 
pseudo-hoof secreted by the coronary band. The fibres of this 
hoof, however, instead of being rectilinear and growing down in 
the direction of the old wall, with the fibres of which they are 
continuous, are, on the contrary, sinuous and nodulated, and dis- 
posed to take a somewhat horizontal direction. There is often, 
besides the old wall, a deep horny tumor, a keraphyllocele which 
grows inside, attempts to replace the soft horn secreted by the 
podophyllous tissue, and adds to the jDressure of the os pedis, by 
forming a new wedge, more solid and resisting, which produces a 
displacement of the phalanx, whose anterior face then often be- 
comes more than vertical. This horny secretion from the coronary 
band is made evident by a section of a foundered foot, when the 
cutigeral cavity will be found much enlarged. Guy on, Jr., Hert- 
wig, and Gourdon remark that the displacement of the os pedis is 
counterbalanced by the more rapid development of the heels and 
the projection of the foot forward ; and that thus the phalanx 
does not support the weight of the body except by its inferior 
border only, but preserving nevertheless, its primitive position. 
It is especially observed that when the foot is completely de- 
formed, the projection of the wall does not prevent the os pedis 
from remaining in its normal position. 

The growth of the hoof from the podophyllous tissue and the 
coronary band is not easily stopped. The horny masses which 
are formed continue to increase, and even soon end in uniting. 
There then remains a thick mass of deformed shape, four or five 
times thicker than the normal wall, but where the keraphyllous 
leaves are still noticed, corresponding to the podophyllous laminae, 
largely developed, and above all, running deeply into the wall of 
the hoof. The space between the wall and the anterior face of 
the OS pedis is filled with pus besides the secreted hoof ; the seedy 
toe, if it existed, disappears. Though the hoof becomes thus 
much more voluminous than before, the deep parts are not any 
more in their normal condition, but are lodged in a smaller and 
smaller space, and are thus in such a state of compression that 
they become atrophied. The bone is altered in its texture, as 



684 



OPERATIONS ON THE FOOT. 




Fig. 519.— Changes of Structure of the Os Pedis in old cases of Chronic Laminitls. 

well as in its form, and becomes denser and more brittle. (Fig. 
519). One might suppose that as the disease jDrogresses, the os 
pedis would become pressed backward more and more toward the 
sole, in consequence of its giving way under the pressure. This, 
however, is not so. As the old normal walls disappear, the new 
horn yields to the pressure frora forward, the heels rise, the os 
pedis resumes its horizontal direction, and the danger of hernia 
of the bone diminishes, and a hypersecretion of the hoof is even 
noticed toward the point where the hernia would have taken 
place, in the middle of the pumiced sole. 

"We have, so far, supposed that chronic laminitis is always 
manifested by the presence, between the internal face of the wall 
and the podophyllous surface, of a mass of abnormal hoof. But 
there are cases, after hemorrhage, and especially after serous 
exudation, where, instead of it, a cavity is found — a seedy toe. 
There is also an entire separation between the os pedis and the 
wall. But the horny production, that of the podoj^hyllous tissue 
especially, is not sufficient in amount to fill up the whole space, 
there being hoof only upon the podophyllous tissue. There is 
then a sound wall formed, separated from the old one by a vac- 
uum, which is often filled by a dry mass derived from the blood 
and serosity, mixed with the horny cells. But more frequently 



DISEASES. 685 

the separation is limited to the height of the podophyllous tissue, 
and the wall yet remains adherent to the coronary band, by its 
cutigeral cavity. The band then continues to produce the ex- 
ternal wall of the hoof, while the podophyllous produces the 
abnormal wall, and the seedy toe remains between the two walls. 
There are cases where the separation, produced by the con- 
gestion of laminitis, takes place to such an extent, in circumfer- 
ence or in height, that the hoof loses all its adhesion, except 
toward the heels ; and then one may see the curious fact of the 
new generation of an entire new nail within the old one, the for-, 
mer being, so to speak, sequestered in the latter. 

IV. Differential Diagnosis. — It is possible that, notwith- 
standing its distinctly characterized physiognomy, laminitis, of 
the hind feet especially, may be mistaken for a disease of the 
sjjinal region. Often, when the founder is light, the hinder parts 
wag, as in sprains of the loins, but the resting of the feet on the 
heels, their heat and their sensibility, will soon point out the dis- 
tinction. In more severe cases, the hinder founder may stimu- 
late paralysis, especially if the animals cannot or will not raise 
themselves. Here the history of the case is very useful, and the 
explorations of the feet will assist in making the diagnosis. We 
have seen cases of laminitis behind, where the raising of the foot 
has been such that it might be taken for springhalt, or even for 
locomotor ataxy. It may be also taken for tetanus when in mild 
form, or yet incompletely characterized. 

V. Prognosis. — Laminitis is so much more alarming and re- 
bellious as to treatment, as it is more extensive, more serious, and 
of longer existence. The most serious cases are those which are 
due to a constitutional predisposition, and those which follow a 
general alteration, or are complicated with other diseases. 

Chronic laminitis is especially serious from the production 
without sej)aration, and in an excessive measure, of the horny 
substance. Seedy toe is then less serious, and that which does 
not extend to the coronary band is sometimes curable by the 
gradual growth of the hoof; the tumor of the os pedis is the 
most rebellious to treatment. The destruction of patients is often 
necessary, from their inability to walk or to do any work, and 
that notwithstanding all treatment they are entirely useless. 

VI. Etiology. — Laminitis has been attributed to many and 
the most varied causes, and, among others, has now been ascribed 



686 OPEEATIONS ON THE FOOT. 

to a traumatic origin, consisting of injuries of the foot ; and again, 
to internal lesions, resulting in the inflammatory process which is 
characteristic of the affection. 

The external traumatic injuries, which it is claimed are those 
chiefly instrumental, are, on the contrary, of very rare occurrence 
as causes of the disease. Our observations agree with those of 
H. Boviley, and if there is a traumatic causation for this disease, 
or, at least, one identical with it in respect to symptoms and 
primitive lesions, it is, nevertheless, certain that its progress is 
very different; there is found with it an evident tendency to sup- 
puration instead of exudation, and there is no such formation as 
the chronic process which is found when laminitis is due to an 
internal phlegmasia. 

It has been said in reference to the action of the heated shoe 
upon the hoof, the percussion of the blacksmith's hammer and 
the pressure of the shoe and of the nails upon the Uving tissues, 
that all these causes together must, as their sure effect, make the 
foot tender, and stimulate in its constituting structure, the con- 
gestion which is the initial phenomenon of founder itself. But 
this assumption may be successfully contested. But shoeing may 
produce many forms of lameness ; never laminitis. It has been 
said that feet of defective conformation are more commonly af- 
fected with founder that those which are well formed. This, 
however, is not so ; feet with contracted heels are no more predis- 
posed to it than flat feet, as claimed by Girard. Traumatic acci- 
dents, as blows, injuries and pressure, produced by stones, crush- 
ing of the feet under heavy weights or under the wheels of a 
truck, etc., may produce a violent congestion of the reticular tis- 
sue of the foot, and consequently laminitis. But this founder 
itself is of too active a character and more complex, perhaps with 
a natural tendency to suppuration, as we have already said. It 
must then be considered as var;)'ing from laminitis proper, or that 
form in which the congestion is of a more passive character, or at 
least internal and somewhat analagou.s to that which is sometimes 
observed in the lungs or in the intestines. It might be better 
described as an "astonishment" {i^tonnement) of the foot, as it is 
sometimes called. 

Laminitis proper is rarely due to a unique cause, but more 
properly to a number of circumstances or to an assemblage of 
various causes by which the horse is at first somewhat indisposed 



DISEASES. 687 

— sick in fact ; and it is only after various general symptoms that 
the disease localizes itself in the feet, or, as the old phraseology 
has it, falls in the feet. 

The most effective cause is too abundant and especially too 
substantial feeding, which produces plethora by rich blood. It 
is the use of other grains than oats, as wheat, barley or rye, 
which especially predisposes to the disease. Latin authors called 
it hordeatlo (from hordemn, barley), and it is mentioned by Sol- 
leysel, Garsault, Gaspard de Saunier, and various hippiatrics. 
Eodet has observed its bad effects in Egypt and in Spain, where 
animals were fed not only with those grains, but where they received 
wheat in spike. Miltenberger had observed the same effects dur- 
ing the war of 1812, in Poland, where the horses were fed with 
rye. Even in our days laminitis is seen breaking out in the years 
when feed is scarce and when oats have to be replaced by other 
grains, as is proved by the observations of Bouley, Verrier, Rey, 
etc. Ai'tificial varieties of fodder also predispose to founder, 
though less often ; even oats, when given in excess, may produce 
it (SoUeysel, Blind), and especially if new oats (Hertwig). 

The influence of seasons cannot be denied, and it is during 
the summer months that laminitis is more frequent, while it is 
rare in winter, as well as in the spring and fall. It is to the warm 
climates of Sj)ain and Egypt that Rodet attributed, in great part, 
the frequency of the founder observed in the army horses en- 
gaged in campaigning in those countries. It has been also attrib- 
uted to the sudden checking of the perspii-ation, and cutaneous 
chills when the animals are sweating ; a cold bath or the drink- 
ing of cold water at that moment having also often been consid- 
ered as occasional causes. 

The work of the horse greatly influences the development of 
laminitis. It is more frequent in those which are driven at great 
speed than in those which work while walking, and especially in 
whose frame an excess of strength is required, and particularly 
those which labor on rough and stony ground. It is almost in- 
e\dtable if the animal is well fed, and if he is unaccustomed to 
that kind of work and not trained for it, and most especially if it 
is during warm weather. This explains why the disease was so 
frequent among post, diligence and coach horses, especially dur- 
ing the period preceding the establishment of railroads, when the 
expenditure of strength exacted from these unfortunate animals 



688 OPERATIONS ON THE FOOT. 

reached the last limits of possibility. More recently, again, dur- 
ing the war of 1870-71, when railroad traveling was more or less 
impeded, laminitis became more common among horses from 
which an excess of muscular effort was required. It is a frequent 
and very serious accident among English race horses (Hering). 

Laminitis in oxen is due almost exclusively to the fatigue of 
long journeys and to repeated frictions of the unshod feet upon 
the ground. It was very common before the era of railroads in 
animals brought to market. 

But prolonged rest and inaction also predispose to founder. 
The disease is frequent in horses making sea voyages. It is not 
rare to see horses become foundered when they are obliged to 
stand up during several days in consequence of injuries to the ex- 
tremities, or other pathological conditions, requiring them to be 
kept in slings. In diseases of the feet which have required pain- 
ful operations (toe or quarter cracks, punctured wounds of the 
feet, quittor, etc.) it is quite common to see an animal persevere 
in maintaining the standing position, and too often has the leg 
corresponding to one first attacked become also affected, leaving 
both of the anterior or both of the posterior ultimately affected in 
a serious manner. 

It is common for laminitis to follow intestinal congestions, 
especially if these result from the administration of a drastic 
purge, as aloes for example, and this is a very serious form of the 
disease. Tisserand has seen laminitis of the anterior extremities 
following parturition in mares, and particularly after abortion. 
Gloag and Smith have observed similar facts. Hertwig says that 
it sometimes follows rheumatismal affections, especially the acute 
form. 

A metastatic laminitis has been seen following diseases of the 
chest. H. Bouley does not believe in these cases, and thinks the 
laminitis is the effect of the quadrupedal standing jDOsition, or 
also the feeding with farinaceous substances in too great quantity. 
At times, founder accompanies malignant fevers, such as anthrax 
and typhoid attacks, which are always accompanied with a certain 
alteration of the blood 

VII. Treatment. — In acute laminitis all attempts must tend 
to remove the congestion of the keratogenous apparatus, or at 
least to abate its intensity, so as to prevent or diminish the seri- 
ous sequelae that may too often follow. To effect this, general or 



DISEASES. 689 

local bleedings have been specially recommendecl, with antiphlo- 
gistic applications upon the congested regions. General bleeding 
at the jugular is especially indicated; a large bleeding of from 
five to ten Htres, repeated if the pulse or the condition of the dis- 
ease indicates it. Local bleeding, often recommended, seems to 
us, generally speaking, to be useless ; that of the toe is of difficiilt 
performance in founder, as the feet are usually raised from the 
ground with difficulty, and the operation is quite painful, and 
may give rise to more or less serious complications. However, in 
serious cases it can be done while the animal is thrown down, not 
so much on account of the blood depletion as to prevent the pos- 
sibility of gangrene supervening. It is more useful in the ox, 
according to Lafosse, who recommends to pare the foot down to 
the quick and to put on the shoe again if the animal has to con- 
tinue its journey. 

The topical appUcations employed are varied and numerous ; 
the simplest and most practical is cold water, cold baths at half 
the leg (Fig. 520) ; take in running water, 
if it can be done, and if the animal stands 
up; walking in the water is then recom- 
mended, if practicable, walking increasing 
the venous circulation of the part. Instead 
of running water, ponds, marshy grounds, 
pools of stagnant water, or even liquid 
manure may serve the same purpose. In 
establishments where horses are numerous, 
there are special tubs where the water is 
constantly changed. The animal may be 
placed in some of these, up to his fetlock, 
in an astringent solution. Mathew has in- 
vented an apparatus for continued irriga- Figs. 520.— Local Coid Douch 
tion, consisting of a reservoir of water ele- Application, 

vated above the body of the animal ; around each coronet is placed, 
in shape of a bracket, a tube of india rubber, perforated with holes 
opening on the hoof ; from the reservoir runs a tube which bifur- 
cates and furnishes to each leg a descending division connected 
with the bracket (Fig. 521). The water is then allowed to run 
around the coronet and drip over the foot. Instead of simple 
water, the use of snow or broken ice has been recommended, 
wrapped in cloth round the hoof ; pads of oakum dipped in solu- 




690 



OPEKATIONS ON THE FOOT. 




Fig. 521.— Apparatus of Matbew for Cold Water Application. 

tion of salt, sulphate of iron, or alum ; clay poultices mixed with 
vinegar have also been used. As the heat of the foot has a ten- 
dency to rise, the temperature of the liquid or of the topic used 
must be often changed in order to keep up its antiphlogistic ef- 
fect. Baths of sulphate of iron are especially indicated in cases 
of traumatism. 

Irritating frictions, used as derivatives, are also recommended, 
but their efficacy in this case is at least problematical. Irritation, 
vrhen the congestion is somewhat passive, is not easy to produce. 
However, frictions of the hock with oil of turpentine, by the pain 
they produce stimulating the animal to move and not allowing 
him to remain in a state of almost complete immobility, may be 
advantageous. Blisters around the coronet are useful toward the 
third or fourth day, when plastic exudation or hypersecretion of 
the hoof are to be feared. 

Frog seton is recommended by English practitioners ; Gabriel 
says it is a sure means to prevent the separation of the nail. This 
seems to us unwarranted. Internally, the administration of ni- 
tre, cream of tartar, ammoniacal salts, sulphate of soda, are given ; 
drugs which are indicated by the febril state ; alkaline remedies, 
and principally of nitrate of potash in large doses, are administered 
to render the blood more fluid and increase the venous circulation. 
Aloes, recommended in England by Hertwig, are contra-indicated, 
as increasing the disease and facilitating the dropping of the foot. 



DISEASES. 691 

It has been advised to take the shoes o£f. This is not only a 
difficult operation, on account of the sufferings of the animal, ob- 
liged to stand upon one leg, but it seems to us useless. Shoeing 
has not the effect supposed of it in the etiology. If it is well 
fitted it is not uncomfortable to the foot, while its removal from 
the foot, by the hammering it requu'es, is always painful, and had 
better be avoided. 

It has been recommended to pare the foot, to shorten it, to 
thin the sole down ; but this operation seems to us in many cases 
superfluous. It is true that the topics will act more readily upon 
the living tissues underneath, but the advantages thus obtained 
do not compensate for the difficulty of the operation ; at any rate, 
it cannot be done except when the animal lies down. 

"We shall pass silently the effect, so to speak homeopathic, 
that English veteiinarians pretend to obtain with very warm 
poultices around the foot, and which have their reasons only when 
suppuration or gangrene is threatening. Neither shall we refer 
to the compression of the foot, recommended by Nanzio — a treat- 
ment which is much nicer in theory than in practice. In a great 
number of cases, the patient is considerably relieved by resting 
on a good bed, and this is especially necessary for severe laminitis 
when locomotion is very painful. However, in less serious cases, 
walking on soft ground, especially on grass, is an excellent treat- 
ment. It stimulates the circulation in parts where the blood has 
a tendency to accumulate, and controls the venous engorgement 
of the keratogenous tissue. It has been sometimes recommended 
to support the animal in slings to relieve him ; but as with this 
one would expose his patient to pulmonary complication, it is bet- 
ter to cast him and keep him in that forced position, being careful 
to turn him over from time to time. 

A dietetic regime, light feeding, during the first days at least, 
cooling drinks, rectal injections and comfortable blankets are aU 
indicated. 

One must particularly watch what takes place in the foot, and 
for this purpose grooves made at the surface of the foot have also 
been recommended; but they cannot be made deep enough, as 
the wall is always there resisting more or less to the eccentric 
forces of the deep parts. 

If toward the third or fourth day there is no marked improve- 
ment, especially in traumatic founder, if even the patient becomes 



692 OPERATIONS ON THE FOOT. 

worse, if the pulsation at the digital arteries is stronger, harder 
and more frequent, it becomes necessary at once to thin the sole 
down, and make a puncture upon the line of demarcation of the 
sole and wall with the drawing knife. Often then a flow of pus 
or blood, more or less altered, takes place, the nature of which in- 
dicates the progress of the disease. If it is of a grey blackish 
color, it is evidence that the horny tissue only is affected ; while if 
white, it indicates a greater change. Hertwig advises this opera- 
tion always, when laminitis is of long duration. He thus pro- 
duces an artificial seedy toe, which is considered the mildest form 
of the disease. He recommends to make a deep groove upon this 
white line so far as there is separation of the wall from the podo- 
phyllous tissue, and then combines the treatment with the use of 
astringent baths of sulphate of copper. We have, on several oc- 
casions, been pleased with this treatment, combining it with the 
application of a blister around the coronet. It is preferable to 
the longitudinal grooves, or to trephining, which is sometimes 
recommended. 

There are numerous cases, however, when, notwithstanding all 
these rational means, the disease cannot be arrested, and when a 
fatally chronic laminitis ensues. This must be considered incur- 
able in the majority of cases. It is almost impossible to bring 
the foot back to its physiological condition, and, above all, to pre- 
vent the hypersecretion of the hoof which characterizes it. 

However, in case of simple seedy toe, if it is the result of 
hemorrhage, or even of suppuration, a cure may sometime be ob- 
tained. Generally, by thinning it down, the entire portion of the 
wall which, at the toe, the mammse and the anterior part of the 
quarters is superposed, to the keraphyllous hoof, without adhering 
to it, is removed. The keraphyllous hoof, also, is thinned down 
in its whole extent ; then a dressing of hoof ointment or tar is ap- 
plied so as to protect it from drying and to keep it supple. In 
these cases, the hoof coming down from the coronary band has 
sometimes united with that flowing over the podophyllous laminae. 
At other times the seedy toe is only cleaned of its contents, and 
is filled with medicated oakum, if there is a wound of the podo- 
phyllous tissue, or with hoof ointment and Venice turpentine, the 
whole being kept in place by a wide web shoe. The last treat- 
ment seems to us the best, only instead of hoof ointment we em- 
ploy gutta percha, melted with gum ammoniac, as recommended 



DISEASES. 693 

by Defays. For this there must be no wound, and the cavity 
must be well cleaned of all substances, or even washed with ether 
to remove all greasy substances which would prevent the gutta 
jjercha from adhesion with the hoof. This course has enabled us 
to see deep seedy toes recover by the gradual growth of the foot. 
Hence, the indication to try to obtain an artificial seedy toe as 
early as possible, as recommended by Her twig. 

When there is thickening of the keraphyUous horn and adhes- 
ion with the wall ; when, also, the toe is formed entirely by a de- 
formed horny mass, the case is more serious and the treatment 
more uncertain. It has been recommended, wrongly, we believe, 
to perform the operation which consists in cutting oif all the pro- 
truding hoof — to even cut off all the accidental production. To 
do this the rasp and drawing-knife are used, the keraphjilous mass 
being thrown down as much as j)ossible. D'Ai'boval has also ad- 
vised to make with the drawing-knife an artificial seedy toe be- 
tween the internal face of the wall proper, which is preserved, and 
the anterior face of the podophyllous apparatus, upon which a 
thin layer is left. This treatment has an advantage over the other 
of keeping the wall intact, to render easier and more solid the 
application of the shoe which is to protect the foot and allow the 
animal to resume his work. This operation, however, is only pal- 
hative. It, however, gives great relief, especially in the first steps 
of chronic laminitis. 

Gross has been satisfied with thinning down with the rasp the 
superior part of the wall, below the coronet, in a width of about 
four centimeters, in such a way that from one heel to the other 
there was only a very thin coat, which he protected with basilicon 
ointment. The coronet was then stimulated with a little oil of 
cantharides. Under this treatment, a new growth of hoof is 
started, not so protruding, and by paring down by degrees the 
hoof, a new foot was grown in a few months, less deformed and 
more regular. 

Meyer and Gunther say that they have obtained good success 
with this treatment, which nearly resembles that of Gohier and 
Dehan, except that with those the entire wall was pared down to 
a thin pellicle, flexible under the pressure of the finger. Silber- 
man advised to place around the hoof, below the coronary band, 
after paring it down thin, a band of steel, two fingers wide, which 
could be tightened by a screw placed at the heels. In this way 



694 OPERATIONS ON THE FOOT. 

the secretion of the coronary band was kept under control, but 
not that of the podophyllous tissue. 

Generally in these cases the suppleness of the hoof must be 
kept up by appropriate topics. It must be cut off when too thick, 
and a shoe miist be applied sufficiently wide in the web to protect 
the anterior part of the sole as far as the point of the frog. This 
shoe must be quite hollow on the foot surface, so as to avoid any 
pressure upon the sole. It must be nailed on principally at the 
heels, as nails at the toe would not hold sufficiently. Between the 
shoe and the foot a piece of gutta percha, or felt or leather may 
be put on. Thus shod, a horse will still do long service, even in 
cities, and much more in the country. 

When there is a wound at the sole, with separation of the part, 
suppuration, caries of the os pedis, which protrudes through the 
sole, it is advised to have recourse to a surgical operation. The 
contents of the abscess vmder the sole must be evacuated, and the 
sole thinned down in the entire plantar region. If the bone is 
carious it is scraped, the necrosed parts are removed, and a proper 
dressing, kept up by plates under the shoe, is put on. There are 
a few cases where, by this treatment, horses have been enabled to 
resume their work. 

Often in chronic laminitis when, notwithstanding the opera- 
tion and the shoeing, the horse is unable to resume his work, ac- 
cording to H. Bouley, the operation of neurotomy will then be 
beneficial. Grad is not of the same opinion. He claims that the 
relief is then uncertain and only temporary. Jessen and Hering 
say that this operation is followed very often by the sloughing of 
the hoof, and the animals stumble very easily. According to 
Braull this operation is followed by a greater growth of the hoof. 
If the lameness is reduced after the operation the deformity of 
the foot continues to increase. 

Navicular Disease. 

Synonyms. — Chronische Hufgenklahme, German; MalacUe 
Namculaire, French. This disease, called by Loisel and H. Bou- 
ley, ^of?osesawic>if?ea^ syno^>^7^s (synovite podosesamoidienne) ; by 
Braull, chronic podotrochlitis, is an inflammation of the sesamoid 
sheath of the horse, that Turner and some other English veterin- 
arians were the first to describe, and which is mostly observed in 
thoroughbreds. 



DISEASES. 695 

The disease is principally seen in the fore feet, and more com- 
monly in one foot alone ; sometimes, however, both legs are 
affected, one first, and the other following. Navicular disease of 
the hind feet is seldom observed. 

It is accompanied with lameness and deformity of the foot, 
and often proves rebellious to treatment. It is followed by con- 
traction of the heels {encastelure) which is itself often mistaken 
for navicular disease. At any rate, the affections are nearly re- 
lated, whether the disease of the sesamoid sheath, first occurring, 
is followed by the contraction, or that the hoof, origiaally con- 
tracted, gives rise to the subsequent alterations of structure 
which constitute navicularthritis. At present we shall only con- 
sider the deep inflammation of the podosesamoideal articulation, 
occurring without primitive alteration in the form of the foot. 

I. /Symptoms. — These are at first obsciu'e. The lesion is 
deeply situated, and is, so to speak, concealed in the hoof, which 
itself, is generally at first of very limited extent. The first symp- 
tom which attracts attention is the lameness, which sometimes, 
indeed, seems to be merely a certain weakness of the affected leg. 
This lameness is at first intermittent and slight, but gradually in- 
creases. WTien in the stable, the animal '' j)oiats," that is, the dis- 
eased foot is carried forward of a vertical Hne, and assumes a 
state of general relaxation of the muscles, with the coronet 
straightened and the foot mostly resting on the toe. This in- 
complete rest of the leg, which is sometimes kept in motion for- 
ward and backward, becomes especially apjjarent if the animal is 
moved backward in his stall. He then sets down his foot with 
much hesitation, and for a short time ; the same thing also occurs 
when, in order to relieve the opposite leg, the animal puts all his 
weight on the diseased one. Still, a close examination of the foot 
fails to reveal any marked lesion ; no change of form appearing, 
no wain at the coronary band ; merely a little heat toward the 
heels, or on the frog, where there can also be found a certain 
amount of low and deep sensibility, made apparent only by per- 
cussion of the hammer upon the foot, or by the pressure with the 
blacksmith's nippers, principally toward the heels and the frog. 
According to Laf osse, the frog is often found indurated, atrophied 
and thrushy. If exercised, the horse frequently stumbles, and 
sometimes falls on his knees; he fears the pain of resting the 
heels on the ground, and is limited in the movements of his knee 



696 OPERATIONS ON THE FOOT. 

and fetlock. If the heels are pared off, in such a manner that the 
frog is well prominent, and the horse becomes much heated, the 
lameness is increased, although at first it may have been very 
slight. Blacksmiths may frequently obtain the same result by 
i^lacing under the foot a bar shoe, which, then resting on the frog, 
and not the heels, greatly aggravates the lameness until it be- 
comes excessive. This mode of diagnosis was originally indicated 
by Brauell : When, after more or less exercise, the animal is left 
to cool off, he at once points, straightens his fetlock, and slightly 
flexes the knee ; the leg has a trembling motion, and no rest is 
taken upon the heels. 

There are, however, according to Hertwig, cases where navicu- 
lar disease suddenly reaches a period where, in the stable, the 
animal avoids all resting on the heel ; points constantly, and hes- 
itates to put his foot on the ground when made to walk. It al- 
ways seems that there must be some traumatic lesion in the foot, 
as a punctured wound or a suppurating corn ; and still there is 
no increased heat m the hoof, and no extraordinary pulsation of 
the arteries of the foot. 

The disease has a tendency to increase, and the animal soon 
becomes very lame upon being put to work, especially on a hard 
road or rough ground. The heat of the foot is increased princi- 
pally after work, though not in proportion to the lameness. The 
sensibility of the foot is also more manifest under the exploring 
pressure of the nippers. In the stable the pointing is well 
marked, and the trembling of the leg gives signs of deep and per- 
sistent pain. It is only after several months of this suffering that 
the foot begins gradually to show a change of shape. It then be- 
comes visibly narrowed and elongated, in a manner which can 
readily be detected both by sight and management. There is a 
general atrophy of the hoof; the periople has disappeared, or 
scales off; the foot becomes covered with ridges, more or less 
marked, but better developed toward the heels ; the frog has be- 
become sunken and atrophied; the sole is ecchymosed, present- 
ing evidences of corns ; and the leg is atrophied, especially about 
the muscles of the shoulder. 

In cases where both fore feet are affected, the animal points 
with either foot alternately, while seeking the desired relief for 
each, but the rest on either is very short. The hiad legs are 
brought under the centre of gravity, the back is arched, and the 



DISEASES. 697 

decubitus prolonged. In stepping out of the stable, both fore 
feet are held stiffly, and kept close to the ground, the animal 
stumbles on his fetlocks, and often falls, and one might suspect 
him of being weak. In walking, his shoulders seem to be rigidly 
attached to his body, but as he warms up the legs move more 
freely and his actions become less limited ; but immediately on 
cooling off, and especially the day following one of hard work, all 
the symptoms reappear, with even aggravated intensity. The 
disease increases steadily with the lapse of time. When one, or 
what is more rarely the case, both hind feet are affected (Loiset 
has seen it occur), the animal is stiff behind; he is lame on one or 
both feet; he puts his foot on the toe only; knuckles at the fet- 
lock; and presently an atrophy of the muscles of the superior 
regions takes place. 

II. Progress, Duration, Termination. — The disease gener- 
ally maintains a steady progress ; nevertheless it very often un- 
dergoes a remission, due to the hygienic conditions in which the 
animal is placed ; to the seasons ; to the state of the atmosphere, 
and to other causes. It may diminish in severity, and its symp- 
toms disappear, while in its first period, if the animals are left at 
rest — without shoes if possible — loose in a box, with damp bed- 
ding, or in a marshy field ; or in winter, during the rainy season, 
while the atmosphere continues in a moist condition for a long 
period. It is, under these circumstances, not uncommon to see 
feet which had become contracted quite recover their natural di- 
mensions. Aside from these exceptional cases of recovery, the 
lesion keeps on slowly destroying the tissues where it exists ; the 
lameness remains constant, or becomes intermittent for years, 
sometimes after the animals have become entirely unfit for work. 
There are frequent complications involving the surrounding 
parts ; sometimes a true arthritis, and besides the complete atro- 
phy of the muscles of the shoulder, the carpal ligament becomes 
thickened, the tendon of the perforans undergoes the same alter- 
ation, and ring-bones and side-bones may follow. Again, how- 
ever, the animal may become knuckled to such a degree that he 
can scarcely rest his foot on the ground at all. 

III. Pathological Anatomy. — As we have said, the disease 
has its seat in the synovial capsule, formed by the small sesamoid 
sheath between the navicular bone and the perforans tendon, slid- 
ing upon it. At first may be observed a certain injection of the 



698 OPERATIONS ON THE FOOT. 

synovia, and a darker hue in the coloration of the trochlear carti- 
lage with the corresponding face of the tendon, the synovia be- 
coming reddish and thick, the surrounding cellular tissue becom- 
ing, also, inflamed and infiltrated. At a later period, when the 
disease has somewhat progressed, there is a thickening of the 
walls of the capsule, which is then filled with a clear citrine ser- 
osity. There is then, a kind of hygroma, a chronic dropsical con- 
dition of the sheath. In the interior of this are also to be found 
fibrous bands, running from the tendon to the bone. If the dis- 
ease is older, erosions are found upon the diarthrodial surface 
of the navicular varying in number and in size, and the tendon 
is roughened on its anterior face with longitudinal fissures. At 
times, it becomes atrophied and thin, dry and brittle; and has 
been found, it is said, ruptured transversely. In many cases, the 
cartilage covering the bone has disappeared and the bone is ex- 
posed, hoUowed and affected with osteojDorosis. The union of the 
bone with the tendon has also been found among the varieties of 
determination. 

IV. Diagnosis. — This disease is at first easily mistaken for 
some form of rheumatic afi'ection. Where pain is the main symp- 
tom it is easily detected, but where there are no other signs of in- 
flammation, it is just the lack of proportion between the intensity 
of the lameness and the serious symjstoms, such as the absence 
of heat ; of special sensibility ; of pulsations in the digits, which 
distinguishes navicular disease from other affections of the feet. 
The error with contracted heels is easier, as here the change of 
form of the foot being primitive, at once attracts the attention of 
the practitioner ; while this alteration in the foot is absent in 
navicularthritis at the outset of the disease. 

V. Prognosis. — Generally, it is unfavorable, as most com- 
monly the veterinarian is called only when the disease has already 
made serious progress and passed into the chronic stage ; and 
again, because of the difficulty of reaching the disease by reason 
of its peculiar location. 

YI. Etiology. — To properly understand the etiology of this 
disease, one must bear in mind the part played by the anterior 
legs in the action of locomotion. Columns of support more than 
of impulsion, it is their office to sustain the weight of the body 
when it is thrown forward by the extension of the hind legs. The 
reaction of the ground is first felt at the shoulders, through the 



DISEASES. 699 

muscular slings which attach them to the trunk, but it is partly 
diminished in the scapulo-humeral joint, which closes, notwith- 
standing the resistance of the muscles implanted on its apex. The 
remaining force is transmitted to the vertical column, represented 
by the union of the radius, the carpus and the metacarpus. Reach- 
ing the digital region, this force is there decomposed. Part of it, 
passing on the phalanx, loses itself and disappears in front of the 
horny box of the foot, the other being thrown upon the flexor 
tendons, and finally upon the perforans, which distributes it to 
the posterior parts of the foot, and to the navicular bone. It must 
be observed that in this complex action of decomposition of the 
shock, the os sesamoid, though pushed from before backward by 
the OS coronse is, however, supported by the resistance of the per- 
forans tendon. Consequently, both the bone and the tendon are 
pressing upon each other, when the feet are placed on the ground, 
throwing the body forward by the impulse of the hinder parts, 
and thus press powerfully against each other. 

When this pressure takes place in an animal going full speed, 
and a good and high stepper, it may commence by becoming 
merely a sHght confusion, but, if often repeated, the result may 
be some lesion upon the corresponding surface of the bone and 
of the tendon, or of the synovial which facilitates theii' move- 
ments. But the energy of action in the animal cannot be con- 
sidered the only producing cause of these lesions, as a vice of 
conformation in the foot, a want of elasticity in its posterior parts 
where the resisting power is diminished, may also produce it. 
The disease, then, is observed in animals whose plantar cushion, 
covered by a small, dry and atrophied frog, is itself badly devel- 
oped, from being compressed between the bars, which are more 
vertical, or the heels, which are more contracted; all these be- 
ing conditions which diminish the flexibiUty of the back of the 
foot. 

Two principal causes, then, co-operate in the genesis of navi- 
cular disease, and are almost always present in animals thus 
affected. On the one hand, it will appear among well-bred ani- 
mals, especially those of English breeds, those from Hanover, 
Mecklenburg and Normandy, which will be more affected. Loiset 
and Lafosse, however, have seen it in common breeds, in animals 
with flat feet and soft horns. Lafosse says he has seen it in mules. 
But besides this influence of the breed, there is the effect of what 



700 OPEBATIONS ON THE FOOT. 

we may denominate the hygiene of the foot ; the too dry bedding, 
certain wrong modes of shoeing and all the predisposing causes 
of contracted heels. Let us add also, as a cause, the effect of 
changing the animals from marshy fields, where they were walk- 
ing on soft, damp ground, to stables with dry bedding — a cause 
commonly present in horses transported from northern Germany 
to the south. Hard work and excessive exercise are also causes 
of this affection — for example, jumping fences with a heavy rider, 
slipping in steeple-chases, racing, a sudden stop on the fore feet, 
especially on stony, hard, frozen or rough ground. All these are 
fruitful cases of navicular disease. 

Traumatic causes, such as punctured wounds, involving the 
sesamoideal sheath, are also productive causes which may origin- 
ate navicular disease. We do not believe in internal causes, nor 
admit, with Loiset, that visceral inflammation, sudden arrest of 
perspiration, especially of the lower part of the legs, can produce 
the disease. We should rather anticipate that these metastases 
would affect more the more important serous structure. Neither 
can we admit, with Lafosse, that this affection can also follow a 
sudden arrest of the milky secretion. 

VII. Treatment. — We have seen, in speaking of the termina- 
tions of these lesion, that in certain peculiar circumstances which 
may be accounted favorable to the I'eturn of the elasticity of the 
foot, a spontaneous recovery is possible. This leads us to the 
measure of the prophylactic means proper to be used; and it 
seems evident that by a better hygiene of the feet, by rational 
shoeing, sometimes educating young horses only gradually to fast 
work, one may in many cases avoid navicular disease. 

While it is in its first stages, one may, with care and patience, 
sometimes reheve the patient. In this case, absolute rest is coun- 
ter-indicated, but on the contrary, moderate exercise, upon even 
and not too hard ground; or, if the lameness is great, walking 
exercise only, at a moderate gait. The absorption of the serosity 
present is made easier by a little exercise than by absolute rest. 
Bleeding from the toe, or the veins of the affected legs, is also, 
at least, superfluous, the disease becoming chronic almost at the 
outset. It is also a good practice to shoe the horse, and above 
all, to remove the shoe frequently. The best shoeing is that 
which allows for the natural expansion of the hoof. The Charlier 
shoe has proved useful, while the bar shoe, which is heavier, and 



DISEASES. 701 

presses upon the frog, is counter-indicated. It is important to en- 
courage the suppleness of the hoof by proper ointment, especially 
the aj)plication of glycerine, and to have under the feet a bed- 
ding always sUghtly damp and soft. The bedding of moist saw- 
dust is very convenient ; we prefer it to poultices, and even to the 
tepid alkaline baths mentioned by Hertwig. At times, at inter- 
vals of about eight days, and then during two consecutive days, 
a good friction with blister ointment above the coronet is advan- 
tageous, as well as one with Lebas' ointment. English practi- 
tioners prefer salines; the better treatment would be to turn the 
animal to grass. Brauell advises iodine internally, and says he 
has found it work well. Others recommend diuretics. Setons in 
the shoulder or chest seems to us inexpedient. We prefer the ad- 
ministration of a purgative ball every eight days. Sewell and 
BraueU advise a seton, running from the hollow of the coronet 
thi'ough the plantar cushion, a little behind the tendon of the 
perforans, and within a short distance, therefore, of the diseased 
capsule, making its exit at the anterior third of the frog. This 
drain is to be maintained for two, three, and even four weeks ; 
Sewell, Brauell, Hertwig, and several other veterinarians, English 
especially, claiming much benefit from it. This seton is intro- 
duced by means of a curved frog seton-needle ; it has been used 
but little in France. Bruner has recently proposed the puncture 
of the sesamoideal capsule with a trochar, introduced into the 
hollow of the coronet, an operation only practicable if the serous 
collection can be felt outward. After the puncture, he recommends 
an injection of iodine. 

Lafosse proposes after the removal of the sole, the transversal 
incision of the plantar cushion, with removal of a part of it, down 
to the tendon, following the axis of the sesamoid; then the cau- 
terization of the bone and its cartilage, in imitation of what is 
sometimes done in punctured wounds of the foot. Brauell recom- 
mended as a useful surgical operation, the section of the perforans 
tendon in the metacarpal region, in order to prevent friction 
against the sesamoid groove, and to allow an easier adhesion be- 
tween the tendon and the bone. But it is to be feared that this 
section, supposing that it proves successful, might so weaken the 
tendon as to render the animal unfit for fast work. 

If navictdar disease should be accompanied with deviation of 
the wall, and contraction, true or false, the treatment will be that 



702 OPERATIONS ON THE FOOT. 

of this affection in its simple form. An operation, often recom- 
mended, has been that of neurotomy, upon the posterior branches 
of the plantar nerves, repeated at intervals of at least fifteen days, 
in order to remove the lameness wholly, without entirely depriv- 
ing the foot of the sensibihty of feeling. Berger, Brauell, Bou- 
ley, Gross, Mandel, and others, have obtained real success by it; 
but it is attended with serious dangers ; at any rate the benefit is 
not of long duration, or about one year. The animal then stumbles 
more readily, and is more exposed to traumatic lesions, etc., and 
it is probable from this cause that double neurotomy is seen to be 
followed by softening of the deep parts of the foot, suppuration, 
sloughing of the foot, while the animal has previously shown no 
signs of pain. Consequently, neurotomy is an operation which 
finds its application only in peculiar and exceptional cases, and 
animals thus operated upon remain fit for light work only. 

QUITTOR. 

Synonyms. — Fesselgeschwur, German ; giarda, ItaHan ; gialarrs, 
Spanish ; javart, French. 

A name of unknown etymology, by which old hippiatrics desig- 
nate various affections of the inferior regions of the legs of the 
horse, donkey and mule, and even of bovines. These possess the 
common character of a degeneration of a portion of the tissues, 
that is expelled by the efforts of nature under the form of a slough 
{hourhillon). There is a softening of the mortified structures, 
and an elimination by suppuration. In several old works, these 
sloughs are called quittors {javars), and this name has been ex- 
tended to the disease itself. 

This name having been preserved by use, notwithstanding the 
efforts of Vatel in opposition, we shall also employ it, and with 
Girard, recognize : 1st. The simple or cutaneous quittor, which 
is only the furuncle which occui's in the thickness of the dermoid 
structure nearest to the coronary band. 2d. The tendinous quit- 
tor, which greatly resembles the felon of man, where a portion of 
the sub-cutaneous cellular tissue, and of a tendon sloughs out. 
3d. The sub-horny quittor, the furuncle of the cutidura of the 
coronary band itself, the slough involving the superior portion of 
laminated tissue. 4th. The cartilaginous quittor, or the limited 
caries of the lateral fibro-cartilage of the os pedis, and which old 
writers compounded with the horny quittor. "We might join to 



DISEASES, 703 

those the furuncle of the frog. We beheve it useless, at present, 
to enter upon a general consideration of quittor, and will pro- 
ceed to examine the pathological phenomena presented by each 
variety. 

A. Cutaneous Quittok. — This is a simple furuncle of the 
coronary region of the foot, in that part of the dermis nearest to 
the coronary band, having, however, a special character on account 
of the extraordinary thickness and inelasticity of the dermis of 
the region it occupies, the result being a kind of strangulation of 
the inflamed tissue beneath, and a very painful compression It 
is through error that some authors have designated by the same 
name, the furuncle of the canon, of the fetlock, and of the co- 
ronet. 

The hind feet are more subject to it than the fore, and it is 
more frequent at the heels, at the flexure of the fetlock, though it 
is also observed on the sides and front of the coronet, in which 
case it is much more painful. Cutaneous quittor has also been 
observed in bovines, where, however, as we shall see as we pro- 
ceed, it is generally comphcated with the tendinous variety, and 
becomes a true felon. 

I. Symptoms. — Cutaneous quittor is characterized by an in- 
flammatory tumor or swelling, warm, painfid, and tense, of the 
coronary region of the foot, the color of the skin being but little 
changed, if it is dark, but if the skin is light then the redness 
is well marked. This swelling is accompanied with a diffused 
sedema, extending to the fetlock, or even to the hock. We often 
find angeioleucites, or rather what we call leucophlegmasiae. The 
lameness is generally extreme, and the animal frequently can 
scarcely rest on the diseased leg. The pain is sometimes so great 
as to induce general fever and loss of ajDpetite, and the animal 
becomes dull and depressed. After acquu'ing certain dimensions, 
the tumor shows a tendency to soften at its summit, its base, 
however, remaining hard for a considerable time. Rising more 
and more, it soon ulcerates at a point from which flows a small 
quantity of bloody pus, followed by the appearance of the slough, 
{bourbillon). An abscess is now formed in the tumor, which, as 
it opens, carries with it a portion of the skin, sometimes Umited, 
at others measuring from four to ten centimeters, and there is a 
slough formed of the subcutaneous cellular tissue which separates 
by the suppuration with the portion of dead skin. This comes 



704 OPEKATIONS ON THE FOOT. 

out by degrees. It is still adherent by its base and cannot be 
pulled out with the forceps unless by tearing and with acute pain, 
and this is often followed by slight hemorrhage. A few days 
later it will, however, become entirely loose, and in its place there 
will remain a cylindroid open cavity extending through the tu- 
mor, from its summit to its bottom, and from this a deep wound 
results, followed by a sero-bloody secretion, mingled with pus. 
As soon as the slough has taken place, or when it begins, the 
lameness subsides, as well as all the other phenomena of the pain. 
The wound heals up rapidly if there is no complication. 

Cutaneous may easily be complicated with tendinous quittor if 
the disease or process of sloughing of the mortified tissues ex- 
tends to the tendons or ligaments of the region involved. This 
complication is specially common in bovines, where cutaneous 
quittor generally gives rise to more swelling and greater suffering 
than in the horse. 

The quittor has quite a rapid progress, and may last from 
eight to fifteen days ; very seldom longer. At times, it seems to 
be a single furuncle ; at other times, there are several existing to- 
gether. Often again, they come in succession, the first one treated 
being soon followed by others. This is said to take place princi- 
pally when the diseased part remains exposed to the action of ir- 
ritating substances, and relapses are prevented .by protecting the 
part from the effects of these occasional causes. 

II. Pathological Anatomy. — It is an inflammation of the 
very abundant sub-cutaneous cellular tissue of the region, spread- 
ing from a starting point ; the inflamed tissues are mortified and 
becomes gangrenous, and by a process of suppuration, the econ- 
omy attempts to eliminate them. The slough represents more 
particularly the inflamed ceUxilar tissue, which is thickened, and 
which has become filamentous and hard and much impregnated 
with purulent serosity. 

III. Etiology. — Contusions of the region, bruises and punc- 
tured wounds are quite frequent causes of cutaneous quittor, but 
it may also take place without evidence of determining causes. 
Mud, manure, urine, all filth in which animals have to walk or re- 
main, are also considered as causes. For this reason the disease 
is more common in the fall and winter, on account of the action 
of cold at times, and frozen mud. It is also more frequent in cities 
than in the country. Ray observes that the mud of cities is al- 



DISEASES. 705 

ways more irritating and contains mineral substances, especially 
lime, alkalines, and salts, and other substances. The gutters of 
some industrial estabhshments have also a direct irritating action. 
D'Arboval has observed that the mud of places where mineral 
springs exist, is more irritating, as also are calcareous soils, where 
cutaneous quittor is more frequent than in any other. Common, 
large horses, notwithstanding their thick skins — or, rather on that 
account and on account of the hair which covers it — are more 
commonly affected than private horses. Towing horses are much 
more exposed to the disease than those otherwise employed. 

IV. Treatment. — As a first direction, during the covirse of 
the treatment it is always a prudent rule not to work the animal 
and to keep it in the stable, the feet being kept dry on a good 
bedding. An internal treatment is seldom necessary to control 
the general symptoms ; if any is requh'ed, ordinary salines will 
generally be sufficient. It is necessary to assist the process of 
suppuration of the abscess by emolients, warm baths, poultices of 
flaxseed or of marshmallows, with melted lard, applied quite 
warm, or by the appHcation of a mixture of honey and bran or 
flour. We have apphed a coating of blister ointment to the tu- 
mor, covered with a warm poultice ; the maturing effect is then 
very rapid. It is often necessary to lance the tumor to reduce 
the pain and prevent the mortification of a large piece of skin. 
This operation is recommended by D'Arboval and H. Bouley, and 
is specially indicated when the tumor is much developed. It is 
then important to incise in the entire thickness of the dermis and 
to a sufficient length, and if necessary to make severel parallel in- 
cisions which will give rise to a copious flow of blood. In this 
mode, the parts are reheved, the pressure of the tumefaction is 
reduced and the gangrene diminished, if not entirely prevented. 
It is necessary — and we insist on this point — to incise so deeply 
that the tumefied skin is divided in its entire thickness. We have 
seen blacksmiths thus operate by the introduction of points of 
cauterization in the summit of the abscess ; but this mode, though 
facilitating the sloughing of the strangulated part and reducing 
the compression, ought not to be preferred to the incision with a 
sharp instrument — cauterization is more painful. 

When gangrene exists and the abscess is open, the incision is 
certainly less efficacious than at the outset, but it is not for that 
reason useless, as it reUeves the pain and prevents excessive com- 



706 OPERATIONS ON THE FOOT. 

pression. "We do not by it attempt to loosen the slough, which 
it is advantageous to have detaching loose itself when it holds 
only by its base. If the abscess, once formed, is slow to ulcerate, 
making a point of cauterization is a good way to stimulate the 
escape of the matter of the slough. This mode of opening pro- 
duces in the part an increase of vital action and forms a sore of 
benign character, which falls off by the effect of the suppuration 
formed underneath, and which is nearly always followed by a 
comparatively speedy recovery. To obtain this radical cure, it 
remains to continue the use of the ordinary means to facilitate 
suppuration and bring on resolution. If the wound is pale and 
covered at the bottom with large granulations, it must be dressed 
first with basilicon ointment and afterward with alcoholic liquids, 
as spirits of camphor, tincture of aloes, or simply an aromatic in- 
fusion ; at times, baths of sulphate of iron, with a little sulphate 
of copper, are indicated ; or, when the wound has become red, the 
granulations vascular and of healthy character, a simple dressing 
of cegyptiacum ointment, diluted in vinegar, is enough. If proud 
flesh develops itself, it must be cut off. It is important to have 
the wound covered with a protecting dressing, which must be re- 
newed daily if the suppuration is very abundant, or it may some- 
times be left on for two days. 

B. Tendinous Quittor. — Synonym: Hornwurne (Germ.) — 
It is the nervous quittor of hippiatres, and the analogue of the 
felon of man. It is again a furuncle, different from the preceding, 
only because instead of being limited to the skin and subcutane- 
ous cellular tissue, there is caries of a portion of the tendons 
(especially the flexors), or of the Hgaments of the region, and also, 
at times, necrosis of the bone with sjTiovitis and arthritis. By 
extension, though we think, improperly, the name has also been 
given to the felon of the region of the cannon, while the applica- 
tion ought to be confined to that of the digital region, situated in 
the fold of the fetlock. 

The quittor may be superficial or deep-seated when it affects 
only the subcutaneous cellular tissue, uniting the skin to the ten- 
dons, or where the inflammation extends to the phalangeal sheath, 
and the pus accumulates into it. Differing from cutaneous quit- 
tor, this form, generally less common, is more frequently seen in 
the anterior than the posterior extremities. It may also be seen 
in cattle. 



DISEASES. 707 

I. Symptoms. — The first symptom is an excessive lameness, 
manifesting itself even where no visible change exists ia the af- 
fected leg. The animal e\'idently suffers great pain, while his 
actions do not aid us in localizing it accurately, though the foot 
is always examined as being the probable seat of it, the animal 
raising it more rapidly than the other from the ground, and rest- 
on it with much caution and hesitation. After from two to five 
days, a phlegmonous tumor appears at the coronet, above the 
heel. It is extremely warm, and much more painful than that in 
cutaneous quittor, the hoof and the skin preventing the free de- 
velopment of the inflammation by strangulating it. The foot 
almost ceases to rest on the ground, but is flexed and raised from 
it, feeling in the parts being very' painful. The swelling of the 
leg extends to the fetlock, or to the cannons, and even to the 
knee. The animal has more or less fever, and when there is a 
deep quittor, he loses all his appetite, and ordiaarily lies do^vn 
and continues in the recumbent position. 

Generally, much time is required for the phlegmon to assvmie 
the character of an abscess, as the slough, being in this case no 
longer formed by the cellular tissue, is slower to define itself. 
This process of suppm-ation is not so well localized ; there is, on 
the contrary, a kind of deep abscess, which probably becomes 
complicated by the resistance opposed to the ulcerative inflamma- 
tion by the aponeurosis of the sheath and the thickness of the 
skin. However this may be, it is always very difficult to recog- 
nize the presence of one or several of these abscesses, even when 
they form in the subcutaneous cellular tissue, and so much the 
more if the purnilent gathering is deeply seated. 

After the opening of the abscess and exfoliation of the slough, 
either with or without the di'opping of a portion of the skin, 
there does not remain the simple wound of the cutaneous quittor, 
but on the contrary, a persistent fistula, running down a necrosed 
point of the tendons or of the fibrous sheaths. At times, almost 
from the outset, we may observe in the fold of the coronet numer- 
ous httle pimples, which terminate in as many deep fistulse, from 
which ooze a more or less thick humor, foetid, puriform and 
bloody. In frequent cases, the disease in unaccompanied with 
suppiu'ation, and there is a swelling, more or less hard, with a 
gradual diminution of the pain and other inflammatory symptoms. 
A more frequent compHcation is the suppurative inflammation of 



708 OPEKATIONS ON THE FOOT. 

the tendiaous sheaths, or even of the digital articulations. There 
may also be a diffused gangrene with separation of the hoof and 
purulent infiltration under the horny box — periostitis, and caries 
of the cartilage. This is the deep tendinous quittor in the most 
severe form. In this last case, especially if there is an accumula- 
tion of pus in the tendinous sheath, the tumor is very painful, the 
sHghtest touch giving rise to the manifestation of extremely acute 
suffering, the hoof being constantly raised from the grovmd. The 
fever is violent, there is a complete anorexia, and the exercise of 
all functions is more or less disturbed. The compulsory resting 
upon the healthy legs may give rise to swelling of the hocks, and 
even to laminitis. 

In cattle, tendinous quittor becomes more painful than in the 
horse, and is always accompanied by a swelling which may extend 
to the knee. Rumination stops, and the animal endures great an- 
guish. The slough is followed by a wound of varying depth, which 
often exposes the diseased articular surfaces of the phalanges. If 
this remains too long, the pus may aifect the interdigital ligament, 
complicate the disease, and even make it incurable. In this case, 
the amputation of one of the digits may sometimes be performed. 

II. Progress, Duration and Termination. — The duration is 
generally pi'otracted; the disease often gives rise to chronic lesions 
difficult to remove. This will be easily understood, if we remem- 
ber that the region affected is composed, between the skin and 
the bones, of synovial capsules, ligaments, tendons and aponeu- 
roses, more or less cellular tissue, and of very strong nervous 
ramifications. If the disease is not very deeply seated or unilat- 
eral, complete recovery may be looked for; but if there are 
chronic lesions, if the articular surfaces become affected; espe- 
cially if particles of bones are sloughing, if the animal recovers it 
will be but imperfectly, and it will usually be accompanied by 
anchylosis of the joint, and diffused gangrene is also a complica- 
tion to be looked for. 

III. Diagnosis. — We said at the beginning that tendinous 
quittor is a very obscure disease ; the lameness is very great, but 
not characteristic ; in proceeding, we referred to the acute local 
pains at the side of the tendinous cord of the cannon, the inflam- 
matory swelling, the increase of local pains, and the general reac- 
tive fever. 

IV. Prognosis. — It is a very serious disease, on account of 



DISEASES. 709 

the possible complications and sequelae. The loss, or the deform- 
ity of a phalanx, which are sometimes arr ,ong the sequelae of the 
felon of man, are in him accidents which never give rise to serious 
comj)lications, or are quickly forgotten, while in the horse such 
comphcations are equivalent to the death of the animal. 

V. Etiology. — The causes are the same as those of a simple 
quittor, which is complicated with the tendinovis kind ; this is also 
observed after the subcutaneous abscesses, frequently resulting 
from bruises, or even from punctered wounds. It is most com- 
monly met with in low-bred horses, and Fisher says that it is 
more frequent, and less malignant, in young than in adult ani- 
mals ; according to this writer, it is a common manifestation of 
distemper. Irritating muds favor its development in the same 
manner in active as in simple quittor. It often appears without 
appreciable causes. 

VI. Treatment. — When tendinous quittor is superficial, it re- 
quires about the same treatment as the simple kind, excej)t that, 
in this case, the counter openings must be made early to prevent 
the sloughs, migrations of the pus and the gangrene. The sur- 
geon must not foi'get that the inflammation in this affection must 
ordinarily terminate by suppuration, and he must bear in mind 
that there is a possibility of the modification of the inflamed cell- 
ular tissue, and that the mortified portion of that tissue must 
slough out, as their presence, too long continued, may be very 
dangerous. The general indication is to prevent, as much as pos- 
sible, the accumulation of the pus, an indication which will be 
best fulfilled by making openings for its escape, even before the 
formation of the abscess. As the tissues which surround the pus 
are very resisting, nature will not be able, or if so, only with great 
difficulty, to efi'ect the expulsion of these matters. It is for this 
reason that it is necessary to assist her operations by making an 
opening for the escape of the pus and of the slough. The opera- 
tion is without danger ; but if it is not performed in good time, 
lesions will be likely to spread, the disease cease to remain a local 
trouble, and the life of the animal become compromised. 

It is also more necessary to make an opening when the puru- 
lent secretion is established, for in this case it is important to 
avoid delay and to facilitate its escape. A simj)le longitudinal in- 
cision, four or five centimeters long, is sufficient, when the collec- 
tion lies immediately under the cutaneous organ. This incision 



710 OPEEATIONS ON THE FOOT. 

must involve the whole thickness of the skin, as far as the ten- 
dons, and should be made in the middle of the coronet region, as 
near the foot as possible. It gives rise to an abundant hemor- 
rhage, which reheves the part, and warm poultices and baths, to 
accelerate the suppuration, are then indicated. 

When the product of suppuration has passed in the tendinous 
sheath, a longitudinal opening of this part towards the most de- 
pendent points, is indicated. To do this, a canulated directory is 
introduced to guide the bistoury ; when the incision is made, the 
pus flows freely, and by this mode the large blood vessels and the 
various ligaments of the region are avoided in the operation. 

Notwithstanding the incision, or if the suppuration had already 
accumulated before it was made, the pus may also accumulate in 
the j)ouch formed by the tendinous sheath behind the tendons. It 
is then very difficult to prevent its collection in those deep jDarts, 
and it may extend to the smaU sesamoid. It is because the pus 
cannot run toward the skin that it filtrates along the tendon. It 
is only by pressure and by injections that the indications presented 
can be fulfilled. After making free incisions, one may try by jjres- 
sure to remove the pus accumulated between the tendons and their 
sheaths, following it by cleansing injections, which must be re- 
peated as often as possible. 

The wounds which remain after the slough, in the superficial 
tendinous quittor, and that which follows the opening of the 
simple or multiple abscesses when it is deeper, are always charac- 
terized by the presence of fistulas running down to some necrotic 
spot of the tendons or of their sheaths. For these, an injection 
is recommended of tincture of aloes, tinctiu'e of iodine, and some- 
times of Villate's solution; lately, dressings with petroleum or 
phenic acid have been used. Phenicated baths, those of suljDhate 
of iron and lotions of permanganate of potash have also proved 
useful. At times, when the fistulas are persistent, it is necessary, 
after enlarging them, to have recourse to actual cauterization with 
a pointed cautery introduced, while at a white heat, down to the 
bottom of the tract. A general dressing of the wound follows, 
with tincture of aloes, sometimes with egyptiacum. The dress- 
ings should be more or less frequent, according to the quantity of 
the pus discharged. We must dress it until the wound is entirely 
healed, and it must, moreover, be carefully watched for fear of 
another infiltration of pus, or the formation of other fistulas. 



DISEASES. 711 

Superficial cauterization is necessary in order to remove the 
induration and swellings likely to follow, and to stimidate the 
resolution. The action of the firing may be stimulated by blister- 
ing, or by an alterative ointment of iodide of merciuy, of sulphur, 
etc. 

C. SuB-HoKNY Qtjittor. — This is the inflammation of the su- 
perior part of the keratogenous appai'atus of the cutidura; or 
even of the superior parts of the sensitive laminge. This quittor 
is, therefore, located under the hoi'uy box, and is more like the 
cartilaginous kind, which old hippiatrics, and especially Solleysel 
and Garsault, describe with it. It generally takes jDlace on the 
quarter, and more seldom at the toe, or at the mammae. Some- 
times it is observed at the heels, but it is then of small conse- 
quence. 

I. Symptoms. — The lameness is very great. The animal 
walks on three legs, and there is strong reactive fever, due to the 
excessive pain — this form of the disease being more painful than 
the others, in consequence of the pressure of the horny structure 
upon the inflamed tissues. At the origin of the nail a warm and 
very painful tumor is found; the foot is hot and the haii*s staring 
on the site of the injury. If the disease has existed for some 
time, there is a separation of the hoof at its origin, due to a sero- 
purulent exudation, and under the hoof suppuration and mortifi- 
cation of a more or less extensive portion of the coronary band, 
or of the laminae will be found. The suppnration which there 
exudes varies, being in rare instances blackish, as it is usually 
found in traumatic injuries of the hoof; or, again, it is white and 
unctuous, with the odor of decajong cheese ; while more commonly 
it consists of a bloody or greyish matter, mixed with pus. 

If the mortified portion is not deeply seated, so that the slough 
can take place readily, the quittor is quite simple, since as soon 
as it has dropped off there is a well marked improvement. The 
pain then ceases almost instantaneously^ and the wound at once 
progresses toward cicatrization. But it is not rare, even when 
the mortification is somewhat superficial, to find the sub-ungueal 
suppuration extending so that the matter runs under the hoof, 
producing at times more or less serious fistula, or a separation of 
the sensitive and insensitive laminae. Girard says it has been seen 
to extend downward to the sole, and to separate it from the vel- 
vety tissue. The deep, sub-horny quittor may be complicated. 



712 OPEKATIONS ON THE FOOT. 

forward, with necrosis of the tendon of the extensor muscle; with 
the inflammation of the joint ; with caries of the os pedis, and 
even to assume the cartilaginous form of the disease by its exten- 
sion to the cartilages of the foot. 

After the recovery of the sub-horny quit tor, if the coronary 
band has been mortified in its entire depth, the foot may present 
permanent longitudinal fissures, or seams, or transversal grooves, 
presenting evidences of the existence of a cicatricial tissue when 
the quittor was in progress. 

II. JPrognosis. — The gravity of this quittor depends upon 
the depth of the disease. When superficial and affecting only 
the siu-face of the tissue, it is easy to cure, but if deeply seated 
it is more serious, on account of the possibility of complications. 

III. Etiology. — Bruises and violent blows are the ordinary 
causes of sub-homy quittor. It is commonly due to overreach- 
ing, or to the wounds occurring when animals are wearing long 
caulks, as in winter. The irritating effect of frozen mud has also 
been admitted as a cause. 

IV. Treatynent. — The superficial quittor requires a simple 
treatment. Emollient baths and maturating poultices are then 
indicated. It is a good jslan to thin the wall with the rasp or the 
sage knife over the whole extent of the furuncular tumor to a 
height of about two fingers. A compress of chloroformed oil, 
while it alleviates the pain, is also indicated to soften the wall. 
It frequently becomes necessary to puncture the tumor, but we 
prefer to cauterize it with a pointed iron, following the cauteriza- 
tion with a poultice of honey with Venice turpentine or camphor. 
Some authors recommend astringent baths, as oak bark, or of 
sulphate of iron. It is often the case that after some interval fol- 
lowing sloughing of the bourbillon, the wound continues to dis- 
charge a liquid secretion, which is an evidence that there is a ten- 
dency to accumulation of matter toward the lateral cartilage, or 
under the wall, in the laminse ; or that there is some carious spot 
existing. In the first, if probing horizontally, a cavity is de- 
tected, it is convincing evidence that a cartilaginous quittor is in 
course of development; in the second case, the pressure and col- 
lection of the matter increases the inflammation of the laminse, 
separates the wall, and complicates the disease, necessitating the 
operation of the siih-horny quittor. 

The removal of the portion of the hoof which covers the lesion, 



DISEASES. 713 

must, however, include more than the purulent center, so tnat the 
diseased tissues may be well exposed and the suppurative process 
detach them readily. This removal, always proportioned to the 
internal lesions, is made either lengthwise, following the direction 
of the hoi'ny fibres, or crosswise. In that case, it will attack only 
a portion of the wall toward its point of union with the skin. 
This latter method, it is true, requires less cutting, but it has sev- 
eral quite serious objections and often necessitates a second oper- 
ation. Even in cases where the growth of the granulations can 
be controlled, and where a good return of the horse is obtained, 
the horse only recuperates its perfect integrity by the slow growth 
downward of the wall. In some cii-cumstances the operation is 
completed by the removal of a portion, or even of the entire mass 
of the sole, when it is separated from the velvety tissue. 

The removal of a portion of the wall must be accomplished in 
the manner which will be indicated for cartilaginous quittor, in 
carefully avoiding the injirry of the coronary band and of the 
podophyllous tissue. The diseased tissue being exposed, all that 
is of bad appearance is removed, the carious portion being freely 
taken off. An ordinary dressing of oakum with diluted alcohol, 
or any other drug, kept in place with a light shoe or sHpper, en- 
tire or ti-uncated, as the case requires, is then appHed. 

As for all wounds of the foot, the dressing needs only to be 
changed when the pus accumulated under the oakum, or other 
peculiar conditions indicate it. It is true that changing the dress- 
ing is an effective means of cleansing the wound, but it has the 
inconvenience of also irritating it, and especially at the begin- 
ning may tend to interrupt the natural process of repair. It is of 
advantage, after the first dressings, to change them as infrequently 
as possible. In this way hemorrhages, which may always be 
looked for, are avoided. This is a point of the first importance. 
It has been proved that even in operations where a portion of the 
wall has been removed, a dressing left on for from fifteen to 
twenty days without removal, was followed by rapid recovery, the 
new hoof growing under the oakum without suppuration. It is 
useless to probe or wipe out the surface of the wound. On the 
second dressing, that is, after a few days, the parts begin to be 
covered with numerous white points, which are so many rudi- 
ments of hoof. These, which at first are soft, white, and isolated, 
gather together by degrees, and first unite into a thin layer, soft 



714 



OPEKATIONS ON THE FOOT. 



and yellowish, which becomes hard and thick ; it is the hoof secret- 
ed by the laminse, which, Httle by little, unites with that coming 
from the coronary band. Excessive granulations or proud flesh 
are removed in the ordinary way. 

D. Caktilaginous Quittor. — HufJcnorjyeJflster (German) — 
{improperly called siib-horny quittor^ by Lafosse, Jr., coronary 
quittor of Vitet;^6ro chrondritis of the third phalanx, by Vatel; 
sub-horny cartilaginous quittor of Girard ; quittor proper of Del- 
wart). This form of quittor is peculiar to solipeds, they being 
the only animals which have fibro-cartilage on the os pedis. 




Fig. 533.— Cartilaginous Apparatus of the Hrrse's Foot, 
a.— Lateral flbro cartilage. 6.— The superior bordor. c— Its posterior border, d. — 
Anterior lateral ligament, e. — Flexor tendons. /.—Extensor tendon, g. — Os pedis. 
h. — Retrorsal process. 

These fibro-cartilages (Fig. 523) are two pieces, which, with 
the plantar cushion, complete the os pedis and form the base of 
the heels, each representing a piece flattened sidewise, a parallelo- 
gram in shape, and extending posteriorly to the coffin bone. 
Their external face is convex and pierced with foramina for the 
passage of veins, and slightly overlies the surface of the bone of 
the foot. It is separated from the skin by a very rich vascular 
plexus. The internal face, concave, is hollowed by vascular 
grooves, and covers (forward) the articulation of the foot and the 
cul-de-sac of the synovial sac which protrudes between the two 
lateral ligaments of that joint. Downward and backward it is 
united to the plantar cushion, either by continuity of tissue, as 



DISEASES. 715 

near the inferior border, or by fibrous bands running from one to 
the other. The superior border, either convex or straight, is thin 
and separated from the posterior by an obtuse angle in front of 
which it presents a deep notch for the passage of the blood ves- 
sels and nerves. The inferior border is attached, forward, to the 
basilar and retrosal processes of the os pedis. Behind this it re- 
flects inward, to continue to the inferior face of the plantar cush- 
ion. The posterior border, oblique, backward and downward, is 
slightly convex and unites with the preceding. The anterior 
border, obHque in the same direction, is more intimately vmited to 
the anterior lateral ligament of the articulation and can be sepa- 
rated from it only by artificial dissection. It sends upon this 
ligament and upon the anterior extensor of the phalanx, a fibrous 
extension, which unites with that of the opposite side. 

In their structure, the fibro-cartilages comprehend a mixture 
of fibrous and cartilaginous tissue, a mixture which is far from 
being homogeneous and even in the various parts. The more it 
is examined forward and near the base, the more its substance is 
seen to resemble that of cartilages proper, being white, flexible, 
brittle, and homogeneous. Toward its posterior part it loses its 
character of homogenity, becomes less brittle and presents in its 
thickness a greater amount of fibrous texture. More posteriorly 
again, the fibro-cartilagiaous structure is more marked. By close 
attention it seems to show cartilaginous nuclei, isolated, and sur- 
rounded with an entu'ely fibrous substance ; and again, at its pos- 
terior extremity it becomes fibro-greasy with much cellular tissue 
and unites with the plantar cushion. The vitality of the cartilage 
is in inverse ratio with its density and consequently is greater in 
its jDOsterior part than toward the base and its anterior extremity. 
This fibro-cartilage may easily and more or less comi^letely be- 
come ossified; old horses are those which most commonly present 
this condition, and draught horses are more subject to it than 
those used to the saddle. It assumes various forms. At times it 
occupies the entire extent of the cartilage, and at others only at its 
base ; sometimes the external surface is ossified, while the internal 
remains in its normal structure ; then again, the ossification exists 
only anteriorly while the posterior is cartilaginous, and it more 
rarely happens that the process consists in bony lamellae, which, 
starting from the base, spread toward various points of its cir- 
cumference. 



716 OPERATIONS ON THE FOOT. 

These fibro-cartilages are generally more developed in the an- 
terior than the posterior extremities. They also present, in one 
foot, this slight difference, that the internal stands a little higher 
than the external. 

Cartilaginous quittor is a serious affection, characterized by 
the partial caries of one of the fibro-cartilages ; it is a partial gan- 
grene whose character is to slowly spread into the cartilaginous 
structure upon which it starts. To be treated with success, it re- 
quires a very regular attendance, and often an operation, which 
consists in the removal of the cartilage. Sometimes this opera- 
tion is indispensable, and its study is interesting, especially be- 
cause, though not as commonly performed as at the beginning of 
this century, it is one which requires a high degree of surgical 
skill for its success. 

I. Symptoms. — A division has been made of an acute and 
chronic form of this disease. Under the first name, is considered 
the earlier period of the affection, that in which there is inflam- 
mation of the cartilage and painful swelling of the part, and when 
the caries or necrosis of the fibro-cartilage is not yet established ; 
or if there is a wound, when it does not yet granulate, and the 
suppuration, if it exists, is very slight. Chronic javart would be 
that in which the partial and progressive mortification of the 
fibro-cartilage exists; for, as Renault has said, it is the ordinary 
termination of fibro-chondritis. 

When free from serious compHcation, the disease is generally 
accompanied with but little lameness ; sometimes there is almost 
none, and animals can be kept at work, especially at a slow gait; 
but if made to trot, the horse will show lameness. It is especially 
when the quittor exists in the posterior parts, that the inflamma- 
tion and the pain are not excessive, because there is then an 
abundance of soft, fatty tissue. But when the caries is more for- 
ward, and is situated more deej^ly, in a point nearer the articular 
surface, the lesion then affects the fibrous tissues and the pain is 
greater. It is sometimes excessively acute. 

Upon the lateral part of the coronet, toward the heels or the 
quarters, more or less tumefaction appears, more or less painful, 
according to the duration of the disease, and in this case more 
or less indurated. In the centre there exists a granulating fistu- 
lous wound. There are one or several fistulse (Figs. 524, 525, 526) 
whose openings show granulations, bleeding easily, their course 



DISEASES. 



717 



^^^m/as, '^s^^A 






'■mi 







Figs 524, 525, 526.— Cartilaginous Quittor. Various Spots of Necrosis. 



718 OPERATIONS ON THE FOOT. 

always forward, running at times in straight lines, at others ir- 
regularly. The tracts frequently communicate and discharge a 
granular, serous and thin pus, of pale greyish color, generally 
odorless, or slightly sanious, containing greenish particles, which 
are but pieces of diseased fibro-cartilage. The pus dries up on 
the surface and adheres to the hoof and to the hair, and some- 
times irritates the surface of the skin. If one of these fistula be- 
come cicatrized, a fluctuating tumor soon appears, close to it, 
which rapidly ulcerates, and then gives rise to another fistula. If 
the disease is quite old, the hoof of the quarter corresponding to 
the necrosed cartilage, loses its perioplic band, becoming rough, 
ramy and cracked, and the wall is thickened, because the irritation 
of the coronary band has stimulated its growth. This change in 
the condition of the wall varies with the length of time the dis- 
ease has existed, and consequentl}', it indicates its duration quite 
accurately, when one remembers that the hoof grows downward 
about one centimeter in each month. 

When cartilaginous quittor is the sequelae or complication 
of the suppurative corn, of a punctured wound by a nail of the 
shoe, or any other affection of the foot, the symptoms proper to 
these diseases are first observed, though the lameness is greater, 
and the fistulse of the quittor is evident. Often, however, this, 
instead of being external and on the coronet, is situated at the in- 
ferior part of the foot, at the internal face of the inferior border 
of the wall, upon the sole, and sometimes connected with the 
wound of some of those affections of the foot. 

II. Pathological Anatomy. — When one examines the cartil- 
age affected with the necrosis proper of quittor, he always finds 
lesions in proportion to the intensity and the age of the disease. 
It is seldom, however, that the portions of the cartilage which 
have undergone the green degeneration, constituting the caries, 
reaches more than one centimeter in extent; they have the form 
of a small plate, of a green color, ordinarily elongated, and adhe- 
rent to the healthy parts of the cartilage by one of its extremities, 
that which is more forward and the deepest. Others have com- 
pared it to the green growth of a seed in germination. The 
points of the fibro-cartilage which are in immediate contact with 
the carious portion, have also a slightly pale greenish hue. These 
are already diseased; there is already a beginning of necrosis; in 
the remainder of its extent the exfoliation is separated from the 



DISEASES. 719 

cartilage by a reddish, soft tissue, which also lines the inside of 
the fistulous tract. This fistula, which extends from the necrosed 
spot to the skin, is but the hollow tract left by the diseased proc- 
ess upon the cartilage, while gradually destroying its substance. 
Always lined with a pseudo-mucous membrane, by a true p3'ro- 
genic ajjparatus, the fistula is often narrow, sinuous, irregular in 
its course and extent, especially if the disease is of some standing. 

Renault, and after him Lafosse, have mentioned a special al- 
teration of the fibro-cartilage which is sometimes met, and which 
Lafosse looks uj)on as a step toward recovery. It is a softening 
of the tissue, anatomically characterized by a loss of the consist- 
ency of the cartilage, resembling the case of the cellular tissue 
becoming indurated, or that of bones deprived of their earthly 
salts after soaking in weak acids ; its yellowish color is then char- 
acteristic. It may be noticed during life, and is recognized by a 
softening in the region of the cartilage, which then yields, giving 
easily to the pressure of the finger; besides this, ^ a probe intx-o- 
duced into the fistulous tract readily penetrates into the softened 
substance. But the true way to diagnosticate this change con- 
sists in raising the coronary band or after thinning the wall ; then 
one wiU see and may feel the true nature of the transformation. 
Lafosse adds that, in presence of this alteration, the removal of 
the cartilage is no more necessary, for then the cicatrization is 
readily obtained by stimulating the sloughing of the necrosed tis- 
sue or by removing it. 

With cartilaginous quittor there is always plastic infiltration 
of the cellular tissue suiTounding the cartilage. Very often the 
wall of the synovial capsule of the articulation of the foot is some- 
what thickened, and in that case there is less risk of injuring it 
during the operation. — (Rey.) 

III. Progress, Duration and Termination. — Left to itself, 
the caries of the fibro-cartilage may last for a long time, through 
difficulty in determining its true nature. Spontaneous cure, how- 
ever, is not impossible, as Renault proved it, and as many practi- 
tioners have seen it, esj)ecially in young and healthy subjects, 
when the disease is mild at its outset and effects parts of the or- 
gans where the fibrous element ^predominates, as in the posterior 
portion of the cartilage. This fortunate result follows the slough- 
ing of the " boiU'biUon " which makes its appearance under the 
shape of a greenish particle. 



720 OPERATIONS ON THE FOOT. 

But, ordinarily, the disease progresses slowly, destroying the 
cartilage by degrees, and the diseased process ceases only when 
the caries has reached the ligament of the joint, which it some- 
times also attacks. The tissue of the fibro-cartilages has not 
the force of reaction possessed by other inflamed structures, and 
which is so well marked in cellular tissue. A process of suppura- 
tion, such as rapidly eliminates the mortified structure, cannot 
very readily take place in it, and when by natural forces the cari- 
ous sjDot is eliminated and pushed outward, the surrounding tis- 
sues are most commonly already affected. These undergo the 
same alterations, and are eliminated in the same manner until 
the entire cartilage is destroyed. This process of caries by repe- 
tition may last a year. 

In its progressive stage, the disease may spread to surround- 
ing parts, such as the os pedis, the j)lantar aponeurosis, the liga- 
ment of the joint, or the sesamoid sheath, all of which may be- 
come the seat of inflammation. They are diagnosticated by the 
greater pain and more marked lameness, symptoms which are 
comparatively light in the simple necrosis of the cartilage. 

Finally, as a possible complication of cartilaginous quittor, one 
may observe an entire emaciation of the animal, an alteration of 
the fluids due to a j^utrid or purulent infection; some authors 
claim to have even seen glanders and farcy follow it ; this is inad- 
missible. 

IV. Diagnosis. — Cartilaginous quittor is recognized only 
when there is a wound from which escapes the product of the 
suppuration and of the necrosis. This pus has nothing charac- 
teristic, notwithstanding what has been said. If it is thinner 
than that of a simple solution of continuity of the region, or that 
of simple quittor ; if it is less foetid than that of bony caries, it 
has, however, of itself some special characters, vaiying according 
to the subject and the degree of the disease, and especially resem- 
bling much that of sub-horny quittor. If the escape of the pus is 
slow, and it is desired to carefully examine it, a simple pad of 
oakum, kept by a few turns of bandages on the fistulous opening, 
will, when removed, give a sufficient opportunity to recognize its 
nature. 

The probing will often assist in distinguishing the cartilagin- 
ous from the simple or sub-horny quittor. In these last, the fis- 
tula is less profound, and does not reach the thickness of the 



DISEASES. 



721 



uouf Til ^« "^^ cartilaginous disease, tte flstiUa is often sin- 
uous, It IS better to use a soft, ijexible instrument, such as a fine 
probe made of lead. Tbe iniection of liquid maytX the plac 

cUrectly, whUe in deeper and uregdar iistute, it will penetrate 
more readUy. The indm-ation of the coronet, th rough ZTll 
appearance of the hoof of the quarter corresponding t^h fis 
tula, mdicate generally a necrosis of the fiL-eartila.e these 
characters ai-e missing m the furuncle. " ' 

V. J^roffuosis.-T^ consequence of the tenacity of the disease 
this form of quittor is always serious; though this gravity has i^ 
our days, greatly diminished, on account o? the meanTof trlT 
ment now in use, which were unknown some thirty 111:0 

most mcurable and which more recently was treated by au opera- 
tion which rendered the animal unfit for work for seveii molZ 
can m the majority of cases be cured in about fifteen days 

fion meftr"' ''°'''™'' ™™'' ™'' '^*P''"'^^ "^ the complica- 
^LJ f*rf "'"■"'' °' """ l'S'«"«'^te. inflammation of the 
articulation of the foot, or of the sesamoid sheath, the extirpation 
of tlie cai-flage itself, done with the greatest dexterity, fs Tot 
e«n a warranty of recovery. It remedies only the nec^'osis o 
he cartilage, but leaves the other diseased processes to pZ resf 
m such a manner that the animal remains worthless if he has not 
to succumb to them. The pain is, besides the other igns one " 
the most important points to consider: very acute, it is generX 
^ht^C"" °"™' ""' '"^'^ *° *^^ ^^'^'-- »f -"ou-:m' 

fe„7f' -^'''°%y— Heavy draught horses are more frequently af- 
fected, on account of their, peculiar work. The most common 

cartUage, it is most common m horses di-awing trucks loaded 

cartUage The same cause exists for horses workin.^ in extensive 
works of buildings, in the construction of railroadlld tZ 
shops of mechanic construction. u m tne 

Owixig to these concUtions, it is also more common in lar^e 
cities than m the country, and more £i-equent in stony an" tT 
po^ roads than in those which are smooth and tiat. Flat fee" 
with low heels, ai-e more exposed than others, as weU ^thot 



722 OPEEATIONS ON THE FOOT. 

whose hoofs are soft. Quittor is more frequent in the fore than 
the hind feet, the fibro-cartilages of the fore feet being more de- 
veloped and more flexible, and because their heels are generally 
lower than in the hind legs. In some, it is more common on the 
internal than the external quarters, while with us, it has been the 
contrary. 

It is often a compHcation of suppurative com ; of punctured 
wounds of the foot, of canker, of simple and sub-homy quittor, of 
grease, etc., which are then the determining causes of the disease. 

VII. Treatment. — "When the disease is recent and the quittor 
acute, and antiphlogistic treatment may be attempted and resolu- 
tion looked for, baths and emollients are generally beneficial. A 
good blister has sometimes proved advantageous, and when it is 
used, Hmited suppuration, with the formation of a simple slough, 
may take place. 

If necrosis is well estabhshed, it is an indication of the neces- 
sity of a recourse to more energetic treatment, in which case sev- 
eral measures are recommended, including the actual and poten- 
tial cautery and the removal of the cartilage. 

In actual cauterization, the necrosed spot is destroyed by a 
cautery brought to a white heat, applied directly upon it, after it 
has been exposed by a free incision. It is a simple treatment, and 
one that has been successful in cases of posterior necrosis where ^ 
much fibrous tissue was diseased, and principally in young and 
well-conditioned animals (Lafosse, Sr., Girard, Vatel, Mangin, 
Renault). Still, this treatment not only often fails, but may even 
become a means of irritation of the fibro-cartilage, and cause an 
extension of the necrosis. (Hurtral, D'Arboval, Lafosse). In our 
day, this treatment is almost entirely ignored by good practition- 
ers, and the potential cautery more generally adopted. 

This had already been employed by hippiatrics. SoUeysel 
principally recommended the use of corrosive sublimate mixed 
with aloes ; Girard, Barreyre and Bernard also mentioning it. 
English veterinarians recommended their use very strongly. 
(White, Blaine, Riding, etc.). These practitioners all used the 
solid caustic, either in the form of trochiscus or in powder, and if 
they obtained good results, it required a much longer time than 
that reqmred in our day by the use of the liquid forms of caustics 
which are at our command. With the solid form, the action was 
of limited extent, and scarcely more effective than that obtained 



DISEASES. ' ' 723 

by the actual cautery; moreover, tliey frequently injured the 
healthy structures by irritating them and increasing the inflam- 
mation, and thus resulting in serious complications. 

As we have said, liquid caustics are largely used to arrest the 
spread of the caries ; they modify the process of decomposition, 
dry up the suppuration and stimulate the tissues without injuring 
the healthy structures. This mode of treatment must be credited 
to Manage, who in 1847 established the unfailing efficacy of re- 
peated injections of Villate's solution; one of sulphate of copj)er 
and sulphate of zinc, 64 grammes of each in 1 liter of Aonegar, 
and decomposed by 125 grammes of Goulard's extract. It is 
really simply a solution in vinegar of acetate of copper and zinc, 
holding sulphate of lead in suspension. Villate himself had al- 
ready used his solution with success by injecting it in cartilagin- 
ous quittor as early as 1829, since which time Burgniet, Verrier, 
Sr., CoUignon and others have recognized the benefit of liquid 
escharotics in the treatment of the same disease. Villate's solu- 
tion is not a specific, and cartilaginous quittor has been cured by 
the injection of tincture of sublimate with solution of nitrate of 
silver (Bernard), with the perchloride of iron, chloride of coj^per, 
sulphate of copper and zinc, nitrate of lead, more or less concen- 
trated mineral acids, and especially the Eabel water (ColHgnon). 

It is difiicult to say which is the more useful of these drugs 
and which has been more successful. Success has also been ob- 
tained with injections of tincture of iodine, phenic acid and even 
petroleum. It is less the nature of the drug that insures the ef- 
fect than the mode of using it. We ought also to say that, ad- 
vantageous as this mode of treatment is, it is not infalHble, though 
Mariage and others so consider it. It is not to be preferred to 
the extirpation of the cartilage, an operation which proves suc- 
cessful when all other means have failed. 

To obtain a cure by the use of liquid applications it is essen- 
tial to make injections every day, and even several times daily. 
These are made with a sjainge, carefuUy adapted in respect to 
size, with a small canula. The injection must be pushed well in, 
but must be allowed to escape freely after coming in contact with 
all the diseased surfaces which it is designed to modify. To effect 
this, it becomes necessary, as the fistulae are sometimes very nar- 
row, and even irregular, to enlarge them, or to make counter 
openings. Mariage had originally insisted that these precautions 



724 • 



OPERATIONS ON THE FOOT. 



were essential to the success of the treatment. H. Bouley and 
Viseur also strongly insisted uj)on the same point, viz., that of en- 
larging the iistula in order that the liquid should not be allowed 
to remain at the bottom of the fistulous tracts, by which aU possi- 
bility of the extension of the disease from that cause might be 
avoided. These enlargements of the fistulas, or covinter openings, 
close, however, very rapidly; as a remedy to which, Hivernat has 
suggested the introduction into the tracts of little wedges of wood 
pointed like pencils, for the purj)ose of lacerating the walls of the 
fistula, followed by the insertion in them of small setons, moist- 
ened with ViUate's solution. Guerrapain introduced a fine meche 
of oakum, a seton in the tract, by means of a curved needle. If 
the fistula runs downward its bottom is under the wall, and he 
thins this down and makes a counter opening through the hoof 
thus thinned. This seton prevents the closing of the counter 
opening, and enables the operator to push through the injection 
regularly. 

Other precautions are also necessary. One, especially, is rest. 
The animal must not be put to work. Lafosse says that these 
liquid caustics act with regularity and cure with certainty. A bar 
shoe, not pressing on the diseased quarter, is also useful. Emol- 
lient poultices are sometimes necessary after the injection, to 
diminish the irritation. Mariage also recommends them. If the 
fistula extends under the coronary band, or the podophyllous tis- 
sue, it becomes necessary to thin, or to remove altogether, the 
hoof of the diseased quarter. 

After fifteen days of this treatment, the exfoliation often takes 
place, and recovery follows. Often, however, twice this length of 
time is necessary. After the first eight days the pus becomes 
more abundant, white and laudable ; the tumor softens and dimin- 
ishes, as the pain subsides. Later, the injections penetrate with 
greater difficulty, which is a good sign. The injections constantly 
attack the germ of the disease and leave it without chance to re- 
form or to spread; the gangrenous structure which develops in 
the cartilage is changed into an inert substance ; the pyogenic 
membrane of the fistulous tract is stimulated; the process of 
granulation becomes more rapid ; the wound becomes more and 
more healthy, and the diseased process ceases. If, however, it 
continues, the wound changes its character, large granulations 
develop themselves, and in their center the openings of the fistu- 



DISEASES. 725 

lous tracts, which open on the cartilage, make their appearance. 
At times the wound closes ; but, after a short interval, opens agaia, 
or another forms at another point. There is then a repetition of 
the same course of treatment by caustic applications — but gener- 
ally this indicates a complication, and suggests the propriety of 
an operation. The injections are generally successful, however, 
and most certainly so if the caries occupies the posterior parts of 
the cartilage. They may even succeed in the anterior parts, when 
the animal is young and of good constitution. But if the cartil- 
age has already become partly ossified, the caustic is irregular in 
its action, and the result becomes doubtful. If the caries is deej) 
and extensive, and especially if the necrosis extends through and 
through to a point corresponding to the synovial capsule of the 
articulation of the last phalanx; or if the necrosis exists on the 
internal face of the cartilage, where it covers that structure, then 
the repeated injections of Villate's, or of any other caustic, may 
be followed by serious complications. An old or complicated caries 
will offer an increased resistance to the treatment by liquid caus- 
tics, in proportion as there is more or less difficulty in bringing 
them in direct contact with the necrotic points. 

The third method of treatment is that of the removal of the 
cartilage. This operation, first recommended by Lafosse, Sr., in 
1754, was often performed by his son, and may be considered one 
of the most valuable results of the application of anatomical 
knowledge to the practice of veterinary surgery. This operation 
was also performed by Bourgelat and his students, by Girard, 
Hurtrel, D'Ai'boval, and was principally studied and described by 
Kenault. In Germany, notwithstanding the writings of Langen- 
bacher, Dieterichs and Hertwig, it did not meet with approval, 
and Enghsh veterinarians seldom, if ever, resorted to it. At pres- 
ent, even in France, it is seldom performed, except in case of fail- 
ure by the caustic injection treatment, and this is often the case 
where the disease is situated in the anterior part of the fibro- 
cartilage, where the cartilaginous tissue predominates, or where 
the vitality is diminished, and above all, where ossification has 
taken place. It is an operation of the greatest delicacy, and ac- 
companied with great risks on account of the proximity of the 
joint of the foot, and it requires an experienced operator and 
thorough practitioner to justify a hope of successful results. It 
consists in the excision, by layers, of the diseased cartilage, and 



726 OPERATIONS ON THE FOOT. 

in avoiding injury to the coronary band, and to the podophyllous 
tissue, which are essential elements of the organization of the 
foot. It is also essential to avoid injury of the lateral ligament 
of the foot joint, which is close to the cartilage, and above all, of 
the synovial capsule of the joint, which is directly covered by the 
cartilage. The partial or entire extirpation of the cartilage can 
be performed. In the first case, only a portion of the necrosed 
fibro-cartilage is removed. Vatel, Sanstas, Renault, Bell and La- 
fosse have reported many cases of recovery by this mode of oper- 
ation, but it is not likely to be thoroughly successful, unless in 
cu-cumstances as favorable as those accompanying the treatment 
by liquid caustics. It is generally much better when the operation 
is decided upon to perform it by excising the entire structure, and 
removing all the carious elements. The partial removal is to-day 
entirely abandoned, and entire extirpation accepted as the true 
and only operative procedure. The best method of performing 
it is that recommended by Renault and adopted in our colleges. 
We shall make it the subject of description with all necessary 
details, and with various modifications as performed by other 
practitioners; we shall also offer some observations upon various 
other modes of performing the operation in question. 

The operation includes two principal steps : first the removal 
of the part, or the whole of the waU corresponding to the diseased 
cartilage ; and second, the extirpation of the cartilage itself. The 
opinions of surgeons vary as to the amount of hoof which should 
be removed, and the extent of horny tissue to be taken off. In 
respect to the length of the superior border of the portion requir- 
ing removal, it is genei-ally agreed that it must extend from the 
anterior extremity of the cartils,ge backward, that is, the two pos- 
terior thirds of the space reaching from the toe to the heels, or 
one-third of the circumference at the coronary band. But opinion 
continues divided as to the lower border (Fig. 527). Lafosse, Sr., 
left it longer than the superior, and made the direction of the 
division of the groove correspond to that of the fibres of the hoof. 
Lafosse, Jr., accepting the idea of Solleysel and of Dieterichs, did 
not reach the sole with its groove, and removed only a portion of 
hoof parallel to the coronary band. Renault prefers crossing the 
fibres of the hoof with the groove, and brings the lower end of it 
to one-half the dimensions of the upper border, its groove running 
backward. Rey considers this to be running too far back and 



DISEASES. 727 




C if 

Fig. 527.— Direction the Groove should take to remove the Quarter in the Operation 
for Cartilaginous Quittor. .-1 B. — According to LafoBse. A C— According to Rey. A D. 
—According to Renault. A £.— According to Lafosse and Dietericths. 

too near the heel, and recommends the groove to be so made that 
the lower border will have the same length as the ujpper, and for 
that reason advises that it be as nearly parallel as possible with 
the line of the heels. Lafosse, Sr., removes too large a portion of 
the hoof. Lafosse, Jr., leaves a portion of hoof which not only is 
useless, but which interferes with certain steps of the operation, 
when with the double sage knife, the skin is separated from the 
external surface of the cartilage, and also, when this is removed ; 
and again, there is a separation between the severed portions of 
the quarters much greater than occurs in the process of Renault, 
which, hke that of Rey, exposes the entire cartilage, and greatly 
facihtates the operation. 

It is to be understood that the foot has been prepared ; that 
the hair has been clipped over the skin covering the cartilage; 
that the sole has been pared thin, down to the blood, as well as 
the bar corresponding to the diseased cartUage, so that the quarter 
has been allowed to project below the sole, to facilitate its e ver- 
sion. The foot has been, moreover, well prepared by two or three 
days of poulticing, to render the hoof easier to be cut by the in- 
strument, and the operation easier to perform, and therefore 
shorter in its various steps, beside jDlacing the patient in the best 
condition for the endurance of so serious an operation. 

After casting the animal upon a good bed, and fixing the feet, 
placing a temporary hemostasis, by the use of a strong cord, simi- 
lar to a tourniquet, aroimd the coronet, a groove is made, using 
various-sized drawing-knives, running from the anterior angle of 
the lower border of the cartUage downward to the sole, following 



728 OPEBATIONS ON THE FOOT. 

the direction recommended by Lafosse, Sr., Rey, or Renault. This 
groove, made first with the widest, and finished with the narrow- 
est of the drawing knives, must not touch the podophyllous tissue, 
and still must run through the entire thickness of the wall, with- 
out producing hemorrhage. In this step of the operation, as 
Girard correctly observes, short cuts of the knife are always bet- 
ter and quicker than those made by scraping or dragging with 
the instrument. It is also important to come down to the soft 
tissue at the coronary band first, and successively downward to 
the inferior border of the waU, as otherwise, as the instrument is 
moved from above downward, with a certain amount of force, it 
might slip and cause a serious division or laceration of the podo- 
phyllous tissue. The separation is then made of the wall from 
the sole by another groove, extending from the end of the groove 
already made, on the quarter, back to the heels. This is done 
without difficulty, with a small drawing-knife, when the foot has 
been properly prepared. There is, however, one point which 
usually offers more or less resistance when the quarter is removed. 
It is that where the wall is continued to the bars. This resistance 
is sometimes so considerable that if much traction is made, the 
wall will break more or less in front of the heels, where it is com- 
paratively thin, and it may consequently become necessary to re_ 
move, by itself, the portion which has remained attached. This 
little accident, however, can be avoided by ascertaining certainly 
before the extraction of the wall is effected, that the continuity of 
the wall and bars has been cut off. This being the case, the com- 
plete separation of the wall from the sole is made by running the 
sharp edges of the double sage knife through the structure of the 
living tissue underneath. The resection of the quarter can then 
be proceeded with. 

For this purpose, a properly constructed lever is carefully in- 
troduced into the groove before mentioned, at the wall and sole of 
the foot. The inferior and anterior angle of the hoof at this point 
being then carefully raised, an assistant grasps it with the nippers, 
turns it back and tears it slowly, while the surgeon, with such a 
motion of the lever as may be necessary, assists in the tearing off 
of the portion of the quarter requiring removal. If adhesions 
remain, interfering with this manipulation, they are removed by 
cutting with a sharp instrument. As this separation of the wall 
reaches about to the coronary band, the separation is very easy, 



DISEASES. 729 

and no fear of lacerating the soft structures need be entertained. 
Care is necessary at this step, however, to avoid injuring the cor- 
onary baud, and the podophyllous tissue ; to prevent which it will 
be prudent on the part of the assistant to press upon the band as 
the separation takes place. 

This being accomphshed, the edges of the wound are carefully 
examined; any projections remaining are removed, and the blood 
is sponged off. The double sage knife is then carefully plunged, 
with the convexity turned upward (that is, toward the skin), be- 
tween the external surface of the cartilage and the internal face of 
the skin, below the border of the coronary band, and then carried 
forward and backward, or as required, until the separation of the 
skin and the cartilage is completed and the external surface of the 
cartilage is exposed. In moving the iastrument backward, it is 
necessary to be very cautious, especially while carrying the sharp 
edges downward and inward, in order to avoid injury to the cor- 
onary band and the skin, of which, however, there can be but little 
danger, when the knife is carefiilly held and properly directed. 
The succeeding step is to separate the skin from the cartilage ; it 
is to be carefully raised and separated from its attachments under- 
neath, which is sometimes a process quite difficult to accomplish, 
as the skin has always become more or less tumefied, and there- 
fore has lost much of its natural flexibility and suppleness. Some 
operators, in order to avoid these difficulties, and overlooking the 
functions of the coronary band, cut it, and remove it, with those 
portions of the skin which cover the cartilage. Others, more con- 
servative (Herting, for example) cut it only through the middle, 
until they reach the superior border of the cartilage, and then, 
raising the two flaps of the skin, accomplish the same result with 
less cutting. 

The destruction of the principal organ of the secretions of the 
hoof having been involved in the first method, and having now 
taken place, it can never be restored to a healthy condition, and 
the animal continues to be exposed to the frequently serious com- 
plications of "false quarter." By the second method, the produc- 
tion of a new wall is nearly always accompanied with the forma- 
tion of a "quarter crack." The recovery is slow in either case, 
and more or less deformity is likely to follow. It is, then, the 
better and wiser plan to separate the skin from below, and to 
avoid the division of the coronary bands or of the teguments. 



730 OPERATIONS ON THE FOOT. 

The next step is the removal of the cartilage altogether. This 
is done with the single sage knife, held firmly in the hand, either 
the left or the right, always, however, that corresjjonding to the 
side of the heel to be operated upon. Taking a point of rest with 
the flat of the thumb upon the plantar surface of the foot, the in- 
strument is pushed between the skin and the cartilage, and the 
sharp edge turned backward, with a firm rotary motion, down- 
ward and forward. The detached portion of cartilage is then 
seized with a pair of bull-dog forceps, and brought outward, and 
the sage knife is brought forward, downward and outward, from 
under the cartilage. It is a good plan, in order to make more 
room for working, to raise the skin and coronary band with a 
blunt tenaculum. The operation should always be commenced 
at the posterior part, in order to avoid the articular synovial cap- 
sule, which might be opened if the removal of the cartilage was 
begun forward. As the operator reaches the anterior part of the 
cartilage, which is situated almost over this capsule, it is prudent 
to hold the foot in excessive extension, and thus avoid injury to 
the capsule. This is an important point to consider in the oper- 
ation. The sharp instrument being carefully handled, every por- 
tion of the cartilage is taken off, either at once, or better by layers 
successively, until the whole is removed. It is thus accomplished 
in three or four pieces. In some instances the anterior portion is 
cut off by a longitudinal incision, made with a straight bistoury, 
following the direction of the posterior face of the coronet, the 
object, in this case, being simply to render the operation easier. 
The cartilage is thus removed, great care being taken to avoid 
opening the capsular articular bursae. It is essentially necessary 
to remove the whole of the diseased tissues, in order to bring the 
parts into the condition of a simple wound. Still, there need be 
no alarm if some small portions remain, more fibrous than cartilag- 
inous, which, deep as they are, may protect the synovial capsules 
or the ligament ; and moreover, they often slough off by them- 
selves, with the abundant suppuration which follows. 

To operate with the greater facility, it is well to have two forms 
of sage knife, one right and one left-handed, and some of extra 
strength, with which to remove the larger particles of cartilage, 
the others being small, thin and light, being adapted to the more 
careful dissection necessaiy toward the lateral ligament, and 
about the synovial bur see of the joint. 



DISEASES. 731 

Toward the end of the operation, the surgeon will, with the 
finger, carefully exj)lore the condition of the parts, to insure him- 
self that the cartilage is entirely removed ; that the articular syn- 
ovial sac has been preserved intact; that the hgament of the joint 
remains perfect, and that the parts are well washed, and ready for 
the dressings. Although in the absence of possible compHcations, 
the operation is now finished, it may yet be followed by some 
serious sequelse, which we will next consider. 

The operation may become complicated by a variety of atten- 
dant and accessory circumstances. Among these are, the opening 
of the articular capsules; the wounding of the anterior lateral 
ligament of the articulation; the ossification of the fibro-cartilage ; 
caries of the os pedis ; and the alteration of the coronary band 
and of the reticular tissue. 

The opening of the articular capsule, either during the oper- 
ation, or by ulcerative process, is not so serious an accident as it 
was originally thought to be. Still, however, it requires some at- 
tention. It only becomes dangerous when the ulceration is ac- 
companied by serious disorganization, and especially when it is 
associated with purulent arthritis. (Renault, Hurtrel, D'Arboval, 
Bernard). It is treated by simple pressure, camphorated paste, a 
little corrosive sublimate mixed with starch, or better, with 
Egyptiacum ointment. 

The u^ound of the ligaments has also been considered a very 
serious accident, which, according to Girard, cripples an animal 
permanently. But Lafosse thinks this an exaggerated notion, and 
claims to have witnessed the radical recovery of animals after the 
necrosis and sloughing of the ligament. 

If ossification of the cartilage is discovered during the opera- 
tion, the removal of all the unossified portion is first proceeded 
with, in order to prevent a recurrence of the disease. The extii'- 
pation of the osteo-cartilaginous portion is then effected, either 
with a small drawing-knife, or the gouge, or the bone forceps. 
The removal is made as far as the ossification is found to be com- 
plete, the operator making svire that every portion of cartilage is 
thoroughly destroyed. If the ossification is but partial or irregu- 
lar, the surgeon must be guided by the condition of the parts. 
When the entire cartilage has undergone ossification, its suscepti- 
bility to caries has ceased. 

When caries of the os pedis exists, the part must be destroyed 



732 OPERATIONS ON THE FOOT. 

with tlie sage knife, the gouge, or the chisel, according to the 
existing conditions. But in this case, portions of the reticular 
structure require removal, of which, however, as little as possible 
should be destroyed. 

It may happen that the portion of the coronary band covering 
the cartilage may be destroyed, either wholly or in part, either as 
an effect of the disease, or by accident during the operation. In 
the first case, if the entire band has been destroyed, there is noth- 
ing to be done. But in the other case, if any portions of it re- 
main, care must be taken to ins\u-e their preservation, as they 
may supply the necessary elements for a new, healthy secretion of 
hoof, and the quarter may grow again, more soUd and less de- 
formed. If the wound of the coronary band consists merely in a 
simple division of limited extent, the wisest course will be to at- 
tempt to obtain union by immediate adhesion, or first intention, 
by bringing the edges of the incision together and maintaining 
the contact by careful dressing. When the alteration of the re- 
ticular tissue alone, is present, it is very essential to avoid the ex- 
cision of the injured laminae. It is, in fact, the better course to 
avoid wholly the use of sharp instruments, and to leave to the 
natural process of suppuration the removal of the disorganized 
parts. Renault having observed how their removal interfered 
with the reparative process, has often left them undisturbed, even 
when their dark color and softened condition indicated the small- 
ness of their chance of conservation. The success of the opera- 
tion after a first dressing, has shown the wisdom of the plan of 
non-interference ; they were found covered with a new layer of 
yellowish hoof; and D'Arboval has on several occasions observed 
the same result. 

The dressing must be methodically and carefully applied. 
Done well, a dressing greatly assists in the recovery, while many, 
when badly performed, have been the cause of serious complica- 
tions, which have greatly hindered the repairing process, and of- 
ten, indeed, rendered a disease incurable, which need not have 
been beyond remedy. In the application of the dressing, two 
points are important to consider: first, Ave must dress the subcu- 
taneous wound, resulting from the separation of the skin and the 
extraction of the fibro-cartilage ; the other, that of the sub-horny 
wound, produced by the removal of the portion of the quarter. 
Both are important, but the second requires the greater care, and 



DISEASES. 



733 



is more difficult and more important than the former ; any excess 
in the sanguineous circulation must be prevented, and excessive 
granulations must be kept under control. The dressing, then, 
must be somewhat compressive, vdthout being excessively rigid, 
in order to obviate possible danger of excessive inflammation ; not 
too loose or so soft as to allow hemorrhage, or the undue pro- 
liferation of granulations. It must be both supple and firm, and 
of an even and uniform pressure. The proper material is balls of- 
oakum for the subcutaneous wound, and pads of the same mate- 
rial for the sub-horny, the first being moistened with alcohol, 
while the others are made dry. 

It is in question whether we should aim to obtain immediate 
adhesive union of the wound resxilting from the removal of the 
cartilage, or in other words, whether it is good treatment to in- 
troduce some material of dressing between the skin and the bot- 
tom of the wound. Here opinions vary. Our behef is, that this 
union is by no means easy to secure ; and that the removal of the 
cartilage, more or less altered, prevents it at various points. Still, 
we must not raise the skin too much, and choosing a middle course 
between, only a small, soft ball of oakum is now placed in the 
deepest part of the wound, or a thin pad is placed between the 
two parts, sufficient to represent about the natural form of the 
part, being enough, however, to 
prevent the immediate reunion 
from taking place. 

A Hght, thin shoe having been 
prepared (Figure 528), adapted 
to assist the application of the 
dressing and its holding prop- 
erly, it is put on with one of its 
branches cut off short on the 
side where the operation has been 
l^erf ormed, while the other branch 
projects backward beyond the 
heel, to support the rollers of the 
bandage of the dressing. Des- 
plas had thought to turn up that 

long branch of the shoe (Fig. 529) 

• /i 1 „j! 1 1, j.^ „„ • I ■„ Fig. 528.— Truncated Shoe for Dressing 

m the shape of a hook to assist m .^ ^^^^ ^^ cartilaginous Quittor or Com. 

holding the dressings. This is plicated Corn. 




734 



OPERATIONS ON THE FOOT. 




Fig. 529.— Desplas' Shoe for Dressing after Operation of Cartilaginous (^uittor and 
Complicated Corns. 

useless. Some veterinarians leave the animal unshod, but the 
bandage is more likely to slip off. The shoe must be put on while 
the animal is down, and before the appHcation of the dressing. 
With some practitioners, that is the moment for the removal of 
the tourniquet or cord, which had been apphed at the beginning 
of the operation in order to prevent the bleeding. This is an un- 
necessary precaution, and only renders the application of the 
dressing more difficult. First, balls of oakum are placed over the 
coronary band, then, upon the points of union of the preserved 
wall and of the podophyllous tissue, and then all over the wound. 
We must endeavor, as Renault says, to give the dressing a cylin- 
drical form, or rather, according to Rey, hemispherical, after which 
the whole is covered with pads and rollers. These must be put 
on in abundance, the rollers passing over the branch of the shoe 
on the soimd side, and running successively from above down- 
ward, and generally from before backward (Figs. 530, 531, 532, 
533). Flat feet require special care in dressing, and the fore feet 
are generally more difficult to dress than the hinder. When all is 
finished, the animal has to be watched for several days. Ordi- 
narily, after the operation, there is abundant hemorrhage, occur- 
ring within some fifteen minutes, and oozing through the dress- 
ings. This requires no special attention, and generally ceases 
spontaneously, or by the pressure of the dressing, or by the use 
of the cold bath. If the dressing seems to be too tight, and the 
animal shows signs of acute pain, with strong reactive fever, it is 
not therefore necessary to remove the dressing, but may be suffi- 
cient simply to loosen the bandage. The animal should be placed 
in a wide stall, or box, if possible, where he may move freely, and 



DISEASES, 



735 



VARIOUS STEPS IN THE APPLICATION OF THE DRESSING AFTER OPERA- 
TION FOR CARTILAGINOUS QUITTOR. 




Fig. 532.— 3d Step. 



Fig. 533.— Dressing Completed. 



lie down easily ; and lie must be jorevented from tearing off the 
dressing by the application of a neck cradle. A low diet is neces- 
sary for several days, in some instances mashes being the only 
food allowed. Still, a good appetite and lively condition are always 
good signs. 

The interval of time which should be allowed to elapse be- 
tween the operation and the removal of the first dressing, should 
be judged by the amount of pain which the animal seems to suf- 
fer ; by the temperature of the atmosphere ; and by the amount of 
liquid discharge found oozing from the wound and moistening 
the dressing which covers and protects it. Generally, the dress- 
ings should be disturbed as late and as seldom as possible. Cir- 
cumstances will sometimes occur, however, which necessitate their 
removal earlier, as for example, the extreme heat of the weather; 



736 OPEBATIONS ON THE FOOT. 

the extremely offensive odor proceeding from the diseased parts ; 
and a sudden and evident increase of pain in the wound, without 
any known cause. Under these circumstances, which, however, 
are of rather infrequent occurrence, it is sometimes necessary to 
remove the dressing as early as the third day, although at this 
time, as suj)puration is not yet well estabUshed, the operation is 
quite painfid, and may be accompanied by free hemorrhage. But 
if the weather is not excessive ; or the dressing remains dry on 
the outside, and matters seem to be generally in good condition, 
the better course is to wait from eight to ten days, before the 
dressing is renewed. Indeed, numerous cases are on record when 
a still longer period has been allowed to elapse, and the re-dress- 
ing has been deferred to the extent of three weeks, or longer. In 
any event, great caution must be exercised in the removal of the 
dressings, and the surgeon should be careful to have all his ap- 
pUances ready in advance, in order that the wound may be ex- 
posed to the air for the shortest possible space of time. When 
exposed, the wound should be of a red color, with commencing 
granulations, and a temporary hoof, soft and whitish in appear- 
ance, should be visible on the podophyllous tissue. A dressing is 
then applied of tincture of aloes, or a weak solution of iodine. 
At a later period the dressings are changed at intervals of about 
eight days, and an application is made of pulverized sulphate of 
copper, in order to facilitate the drying and hardening of the soft 
hoof. Baths of sulphate of iron, with a small portion of sulphate 
of copper are of service in promoting and hastening the cicatriza- 
tion. 

About the thirtieth or fortieth day after the extirpation of the 
cartilage, the animal may be put to hght work. But three or four 
months, if not a longer period, must elapse, before it wUl be safe 
to task him with heavy labor. Toward the end of the assigned 
term he should be fitted with a bar shoe, shortened on the side 
where the quittor has existed. If the dressing is skillfully applied 
and proper care is exercised, the diseased foot may be sufficiently 
protected, and the animal made to resume his work with safety. 

In time, the portion of hoof secreted by the coronary band 
unites with that of the podophyllous tissue, and after a few 
months, no remains of the operation are visible. But if the cor- 
onary band has ulcerated; if the skin has been divided; if by 
contact of the firing iron, or application of caustics, it has been 



DISEASES. 737 

destroyed; the quarter then presents irregularities, and some- 
times divisions, which may be of long continuance, and give rise to 
a lameness which may, perhaps, become permanent. This danger 
indicates the necessity of exercising the utmost skill and caution 
in operating, in order to avoid possible injuries to the coronary 
band. 

Several modifications of the ordinary mode of operation have 
been proposed. Some have had for their principal object, the 
prevention of the extraction of the hoof, with a view of thus re- 
turning the animals to their work at the earliest period practic- 
able. It is thus that Hazard, Jr., proposed to make a crucial 
incision upon the skin covering the fibro-cartilage ; the four flaps 
being so dissected as to expose it, and then removing it with the 
sage knife. In this process, the extirpation of the entire cartilage 
becomes extremely difficidt without inflicting injury vipon the lat- 
eral ligaments and the synovial capsules. 

Pagnier has proposed to merely thin down the quarter, to 
make an incision in the skin along the sujDerior border of the car- 
tilage, and through this to remove the organ. But in this opera- 
tion, however thin the hoof may be, it always interferes with the 
entire extirpation of the cartilage. 

Bernard, following the idea of Lafosse junior, who only re- 
moved the superior border of the wall, proposed a mode of j)ro- 
ceeding which is principally useful in cases of separation of the 
hoof. Instead of removing the band of hoof parallel with the 
coronary bourrelet, Bernard pared it down with the drawing- 
knife, the sage-knife, or the rasp, in order to make it as thin as 
possible, while avoiding the injury to the sensitive laminae. This 
done, an incision is made along the coronary band, below it, de- 
stroying its union with the laminae. At this step of the operation, 
the indications are the same as in the ordinary modus operandi, 
except that the coronary band being covered with a certain thick- 
ness of hoof, is less flexible. This, however, is easily removed, as 
soon as it becomes softened. The remaining steps of the opera- 
tion are the same as in the ordinary, old way. That is to say, the 
posterior part of the cartilage being well defined, the sage-knife 
is used in the same manner. In this method, however, as the 
sage-knife works more flat-wise, there is less danger of wounding 
the ligaments or the synovial capsules. If any part of the car- 
tilage remains near these organs, some care must be used in 



738 OPKKATIONS ON THE FOOT. 

removing it, and it must be done by degrees, and in very small 
portions. 

The advantages of this process are: 1st, the avoidance of ex- 
tensive wounds, and of the extreme pain produced by the extirpa- 
tion of the quarter. 2d, to keep the foot shod, and to allow the 
animal to resume his work as soon as the first pain has subsided, 
which may occur at quite a considerable interval in advance of 
the perfect cicatrization of the wojind. 3d, to avoid long and fre- 
quently-repeated dressings. 

In this method, however, the quarter left intact sometimes in- 
terferes vnth the operation, and the excision of the cartilage is 
more difficult, being only practicable, indeed, in cases where there 
is a separation of the wall. 

Maillet has modified the method of Bernard, so that, instead 
of thinning down the band of hoof, he only appHes the rasp upon 
the quarter, and thins down with it all that portion which is ex- 
tirj)ated in the process of Eenault, and availing himself also, of 
the drawing and sage-knives. The remaining details of the oper- 
ation are like those of the ordinary processes. An objection to 
this mode is that it can be put in practice only in cases where 
there is already a separation of the wall. It is objectionable from 
its tendency to weaken the foot too much, by interfering with the 
firm and soHd adjustment of the shoe, as well as retarding its 
application to the hoof. 



CHAPTER XIV. 
OPERATIONS UPON THE EYE AND EAR. 

ON THE EYE. 

OplitKalmology, though it has made appreciable progress in vet- 
erinary practice within a few years, has not yet reached a position 
corresponding with that which it occupies in human surgery, and 
probably will not for years to come, if ever. The difference in 
value and importance between the functions of the organ of sight 
in the man and in the horse is too measureless to induce or re- 
quire an equal amoimt of interest and study in the optical path- 
ology of the two animals, the human and the equine. It is in- 
deed, a fact that many of the forms of disease which affect the 
eye of the horse have not yet been recognized and investigated by 
students of veterinary medicine. 

For these reasons the contents of the present chapter will be 
limited to those affections in which, strictly speaking, special sur- 
gical interference has been so imperatively needed as to compel 
the attention of scientific veterinarians, by considerations of both 
duty and interest. 

We shall consider the subject ujider two principal divisions, 
or heads, viz., operations, performed on the accessory, and those 
pertaining to the essential organs of the ocular apparatus. 

1. — Operations Perfoemed on the Accessory Ocular Organs. 

On the Eyelids. — These constitute the two cutaneo or mu- 
cous veUs, which are situated in front of the organ, and are divided 
into superior and inferior, uniting at their extremities to form the 
angles or commissures of the eye. Besides these, there is a pecu- 
liar apparatus situated on the internal or nasal angle, known as a 
third eyeUd, or menhrana nictitans. This is a small cartilage, 
thinned out on its free border, continued on its posterior portion 
with the adipose cushion of the eye, and covering it in front, 
wiping, as it were, its corneal surface, whenever the ocular globe 



740 OPERATIONS UPON THE EYE AND EAR. 

is drawn back into the orbital cavity. On the internal commis- 
sure are found the caruncula lachrymalis, showing on the upper 
and lower lids the lachrymal pimcta, both of which empty into 
the lachrymal sac, which is itself continuous with the lachrymal 
canal, and through the lachrymal duct empties at the lower com- 
missure of the nostril by the lachrymal opening. 

Among the surgical diseases of the eyelids must be mentioned 
traumatic lesions, pathological growths, defective congenital con- 
formations, and specific diseases of their elements. 

A. — Traumatic Lesions. 

JBruises of the eyelids are specially common in horses after 
kicks and blows in that region, and may also be the resvdt of fric- 
tion and chafing from the harness. If the cause has been severe, 
oedema of the lid is the result, as well as more or less flow of 
tears, and, possibly, irritation of the cornea. These accidents are 
generally of no great severity so long as the globe of the eye re- 
mains intact, but if this is injured serious complications ensue. 

The indications of treatment are those of all similar injuries 
of a local character, consisting of cooling astringents, with local 
bleeding, which generally bring rapid rehef. 

B. — Solutions of Continuity. 

These are very common with all our animals. They are sel- 
dom simple, but are more commonly complicated with lacerations 
of the tissues, by nails, hooks, etc., or even the teeth of other 
animals Clean wounds by sharp instruments are rare, and are 
easier to treat than those having torn and irregular edges. They 
may be superficial, and may involve the thickness of the lid alone, 
but they may also be deep and complicated with wounds of the 
globe of the eye itself. The condition of the wound in this re- 
spect is important to know, and should be ascertained as early as 
possible. The raising of the eye with the elevator palpoebrum 
(Fig. 534) greatly facilitates this examination, and the animal sel- 
dom offers any serious resistance to it. 




Fig. 534.— Eyelids Elevator. 



SOLUTIONS OF CONTINUITY. 741 

Simple lacerations of tlie lids commonly heal without any treat- 
ment beyond mere cleanliness — a soft sponge and a little clean 
water. But the application of the pin or twisted sutui-e, in con- 
nection with antiseptic measures will greatly promote cicatrization 
by the first intention. Care must be taken to confine the animal's 
head in such a manner as to prevent him from rubbing the wound 
until cicatrization is weU estabUshed. 

C. — Defective Congenital Confoemations. 

Under this head we shall consider the deviation of the hds, 
either outwardly or inwardly, from the convex lines of the cornea, 
with which they should be parallel. A deviation in the growth 
of the eyelashes, or cihse, is another annoying ii-regularity of the 
same region. The outward deviation of the eyelid is called ectro- 
pion; the inward, entropion. The deviation of the eyelash is 
known as trichiasis. 

1. Ectropion. — The two principal causes of this abnormal 
condition are an excess of mucous membrane or deficiency of 
skin. Again, the ectropion depending upon paralysis of the orbic- 
ularis palpcebrum, is of a different nature. Ectropion occurs more 
frequently in the lower than in the upper hd When depending 
on a want of skin, it is generally the result of a wound or a burn, 
or possibly of an abscess, and is a cicatricial ectropion, in which 
the retraction of the cicatricial tissue has carried the lid with it. 

Paralytic ectropion is the result of age, and is more or less 
peculiar to old animals. It may also result from a diseased condi- 
tion of the conjunctiva, or of some of the organs of the orbital 
cavity. 

The treatment of a case of this afiection should be modified 
by the nature of its cause. If it is due to excess in the mucous 
membrane, the redundancy must be reduced. If caused by want 
of cutaneous surface, the remedy must be applied to that surface. 
If a hyphertrophied, mucous membrane is the trouble, astrin- 
gents, caustics, and scarifications must be employed; or even the 
removal of portions of the conjunctival mucous membrane, with 
the scissors or the bistoury. If, on the contrary, the deformity 
results from the condition of the skin, hlepharoplasty or hlep)ha- 
rortapy must be resorted to. The simplest manner of operating 
consists in amputating a V-shaj)e jDortion of the eyehd and uniting 
the edges with stitches. 



742 OPERATIONS UPON THE EYE AND EAR. 

2. Entropion. — This is a malformation in which the border of 
the lid is turned inward. While in an ectropion the skin is in 
excess, the reverse condition is discovered here, where it is defi- 
cient. It is often the result of ophthalmic attacks, and it may 
also follow a loss of substance ia the conjunctiva, after ulceration, 
or the removal of foreign growths. According to Leblanc and 
D'Arboval it may follow some eruptive fevers, or parasitic dis- 
eases. In entropion there is an increased flow of tears, abundant 
muco-purulent secretion, keratitis, which may become ulcerative, 
and loss of sight. 

The treatment consists in the excision of all the inverted por- 
tion of the deformed lid, which is accomplished by raising it from 
the globe with a forceps, and separating it with a single cut of 
the curved scissors, the protruding portion being then amputated. 
The hemorrhage is stopjjed with cooling lotions. 

Another mode of operating consists in cutting off only a por- 
tion of the skin of the lid, and unfolding it by passing the finger 
under the inverted border. Then a fold of skin is amputated near 
the free border of the lid, and the edges brought together by 
twisted pin suture. 

3d. The deformity of trichiasis, or abnormal growth of the 
lashes has been observed by Leblanc in sheep, but in our domestic 
animals is a rare disease. 

Amputation of a portion of the skin ; pulling out the eyelashes, 
followed by cauterization, and extirpation of the free border of 
the Hds, have all been recommended against this abnormality of 
cutaneous secretion. 

D. — Pathological Growth and Caries of the Membrana 

NiCTITANS. 

Acute inflammation of the third eyelid, either as a symptom 
of ophthalmia, or resulting from direct traumatism, such as blows, 
or the presence of foreign bodies, terminating in caries of the 
constituent cartilage of this delicate organ, or the formation and 
development of epithelioma of the mucous membrane, are condi- 
tions often seen in our domestic animals, principally in horses and 
dogs. We have often noticed this peculiar affection, so easily 
recognized by the presence at the nasal angle of the eye, of granu- 
lating masses of various sizes, protruding at their internal commis- 
sure of the hds, and over the surface of the cornea, accompanied 



DISEASES OF THE MEMBRANA NICTITANS. 743 

with more or less suppuration, lacrymation and ectropion of the 
lower Ud. 

The epithelial growths, when small, will sometimes disappear 
under the appHcation of caustics, or can be removed with the 
Hgature, or by direct amputation with fine scissors. In some 
cases they assume very large dimensions, the mucous membrane 
becoming more or less ulcerated, and the cartilage itself diseased, 
and amputation of the entire cartilage becoming necessary. 

This operation is not of recent origin, having been per- 
formed, within our knowledge, some years ago, though entirely 
upon emj)irical grounds, in tetanic cases, from the fact that 
the protrusion of the membrana nictitans over the inner side 
of the external surface of the ocular globe, qmte out of its nor- 
mal position, had often been noticed among the symptoms of 
lock-jaw. The removal of the '•'• haxcck^'' as the operation was then 
called, has never, however, for the reasons which were them ac- 
cepted, become legitimized among the theraj)eutics of the scien- 
tific veterinarian. The removal of part, or what is more effectual, 
of the whole of the membrana nictitans requires three instru- 
ments, a speculum ocuh, a special forceps, like that of Snellen, 
and a pair of curved blunt scissors. 

The animal must be thrown, and the eye being anestheticised 
with cocaine, and the lids kept weU apart with the specvilum, the 
organ, with the mucous membrane which covers it, is drawn out 
with the Snellen forceps, and by degrees severed in its continuity. 
"WTien it is loosened sufficiently to be brought entirely out of the 
orbital cavity, it is separated with the scissors from all its attach- 
ments. The adipose mass which was then slightly protruding re- 
turns to its position and the operation is concluded. 

There is always a Httle hemorrhage accompanying the dissec- 
tion, which, however, is readily subdued by means of a simple 
compress of cold water. No special subsequent attention is neces- 
sary. 

n. — Operations on the Lachrymal Apparatus. 
A. — On the Caruncula Apparatus. 
The caruncula lachrymalis is sometimes the seat of hypertro- 
phy, as commonly seen in cattle, the vague designation of Encarh- 
this being given to all such lesions of the caruncula lachrymaHs, 
whatever may be their origin or nature. 



744 OPEKATIONS UPON THE EYE AND EAR. 

It is an affection which is quite frequent in dogs, as the result 
of localized chronic conjunctivitis. It is characterized by a tume- 
faction of the organ, more or less developed, pedimculated, pro- 
truding in the inner commissure of the lids, and accompanied 
by lachrymation, caused by the obstruction of the lachrymal 
punctse. 

While at the outset anodynes and astringent collyria may some- 
times control its development, there are many cases in which its 
removal by ligature or excision is indicated. SUk is recommended 
by Leblanc as the best material for a ligature, but elastic thread 
is in our judgement much to be preferred. 

Excision is far preferable. The operation is a simple one, con- 
sisting in merely severing the peduncle with a curved scissors or 



Fig. 535.— Bistoury for the Excision of the Encanthis. 

a bistoury (Fig, 535), ad hoc. The comparative abundant hemor- 
rhage that follows is controlled by cold water applications. The 
woimd which remains is treated on general principles. 

H. — On the Lachryinal Ducts. 

The occlusion or obliteration of these little canals by foreign 
bodies, or as the result of inflammation of their mucous membrane, 
sometimes occurs in horses. Its characteristic symptom is an 
abundant and continual lachrymation, and it is only by careful 
examination of the condition of the orifices of the lachrymal pamc- 
tse, that a correct diagnosis can be assured; a thick, muco-puru- 
lent discharge sometimes oozing from them. Though this diffi- 
culty often subsides by resolution of the inflammation, or the use 
of washes and collyria, there are cases where surgical interfer- 
ence, of the nature of a true catheterism of the duct, with possi- 
bly an enlargement of its canal with the bistoury, cannot be dis- 
pensed with. The probe of Bowmann (Fig. 536), and the knife 
of Weber (Fig. 537), answer the purpose very well. 

The animal is placed in the decubital position, the grooved 
probe introduced into the duct, and its wall divided with the knife, 
guided by the groove of the probe. 



ON THE LACHBYMAL APPABATUS. 745 



Fig. 536.— Probe of Bowmann. 



FiG. 537.— Knife of Weber. 
C. — On the Lachrymal Canal. 

The obliteration of the lachrymal canal may become necessary 
in consequence of changes in the structure of its walls, or the 
pressure made upon it by the surrounding parts. In the first 
case, it occurs as the result of traumatic lesions, or of inflamma- 
tion of the mucous membrane, the exudates accompanying it, and 
the accumulation of thick secretions in the channel of the canal. 
In the second case, it is due to severe rhinitis, swelling of the in- 
flamed mucous membrane of the nasal cavities, polypi, bony growth 
of any kind, or in cases of dental caries. 

The symptoms are : Lachrymation, filling up of the canal, its 
inflammation, and arrest of the flow of the tears through the 
lachrymal opening at the nose. 

According to Professor Leclainche, there are four modes of 
treatment for the relief of this trouble. 

1st. Opening of the natural tract and reinoving the cause of 
the obstruction. — This is done by the catheterism of the canal by 
means of fine probes, or by detersive injections forced through 
the inferior opening in the nostrils; or, again, as practiced by 
Director Trasbot, by insufflation. 

2d. Making an Artificial Tract. — If the point of obliteration 
is situated near the lower opening of the canal, an artificial open- 
ing can be made above it. To do this, Leblanc recommends the in- 
troduction of a whalebone probe through the superior lachrymal 
opening into the canal until the place of obstruction is reached when 
a counter opening is made with a fine bistoury through the walls 
of the canal. Two or three silk threads are then introduced into 
the new passage between the two openings and left in place for 
about twenty days. 

If the obliteration is in the bony portion of the canal, and 
cannot be overcome with the silver probe, the perforation of the 
lachrymal bone and an artificial fistula must be made. 



746 OPERATIONS UPON THE EYE AND EAR. 

Neither of these operations is often followed by successful re- 
sults, although the perforation of the bone enables the tears still 
to escape in the nasal cavities. The formation of a fistula fur- 
nishes a channel for the flow of the tears over the lachrymal sur- 
face of the face. 

3d. Obliteration of the Natural Tract. — The intention of this 
operation is to effect the entire obHteration of the duct from the 
lachrymal puncta and the lachrymal duct down. It is obtained by 
the cauterization of these parts, either alone or inclusive of the 
obliteration of the lachrymal sac. Tincture of iodine often pro- 
duces the same effect. As the result of this treatment, the flow 
of the tears takes place over the face. 

4th. Extirpation of the Lachrymal Gland. — This is not re- 
ferred to as a practicable measure, but only because it is some- 
times mentioned in the way of theorizing. The situation of the 
gland in our domestic animals renders the ojoeration an impossi- 
bihty. 

III. — Operations on the Essential Organs of Sight. 

On the Globe. — The essential organ of vision, or ocular globe, 
is a membranous ball, comj)letely closed, and filled with transpar- 
ent fluids of different densities, and popularly known as the humors 
(or media) of the eye. 

This ball, nearly spherical, flattened from backwards in front, 
has its greater convexity in front, where it is closed by the cornea, 
a transparent expansion, thick and resisting ; the glass of the eye. 
Posteriorly, it is composed of three capsular, concentrical sheaths, 
proceeding from without inward. These are the fibrous sclerotic, 
the choroid and the retina (Fig. 538). 

In the cavity of the globe one of these membranes — the cho- 
roid — throws out, perpendicularly to the great axis of the organ, 
a septum, the iris, a kind of contractile diaphragm, perforated in 
its center by the pupil. 

The retina is a membrane of special nature, being an expan- 
sion of the optic nerve, and performs the function of receiving 
the impressions of hght, and transmitting its impressions and 
images to the brain. 

The humors of the eye are three, considered from before back- 
ward, the most anterior being the aqueous, the most posterior the 
vitreous, with the crystalline lens in the intermediate position. 



ox THE ESSENTIAL ORGANS OF SIGHT. 747 




Fig. 538. —Theoretical Section of the Horse's Eye. 

a.— Optic nerve. 6. —Sclerotic, c— Choroid.— rf.— Retina, e —Cornea. /.— Iris.— 
p/t.— Ciliary circle i,or ligament) and processes given off by the choroid, though repre- 
sented as isolateJ from it, in order to indicate their limits more ck-arly. 1— Insertion 
of the ciliary iirocesscs on the crystalline lens. J.— Crystalline lens, fc.— Crystalline 
capsule. Z.— Vitreous hody. «i.»i.— Anterior and posterior chambers, o.— Theoretical 
indication of the membrane of the aqueous humor, pp. — Tarsi. (77— Fibrous mem- 
brane of the eyelids, r— Elevator muscle of the upper eyelid, ss.— Orbicularis muscle 
of the eyelids. <.— Skin of the eyelids, v —Conjunctiva. 1;.— Epidermic layer of this 
membrane covering the cornea, x — Posterior rectus muscle. 2/.— Superior rectus 
muscle, z —Inferior rectus muscle, w —Fibrous sheath of the orbit (or orbital mem- 
brane). 

To this essential organ are added as accessories, first, a mus- 
cular aipparatus, constituted by seven muscles — ^.posterior straight 
or retractor^ four others, also straight, the superior, inferior, ex- 
ternal and internal; and two oblique, or rotators, the great and 
small, or external and internal oblique; second, an adipose ptad; 
third, an apparatus of lubrication, composed of the lachrymal 
gland and its means of conducting the tears, the j^roduct of its 
secretion, viz., the hygrophthahnic canals, i\\ep>uncta lachrymalis, 
the caruncula lachrymalis, the lachrymal ducts, the lachrymal 
sac, and the lachrymal canal. 

The whole mass of this apparatus is enclosed in a conical 
fibrous sac, the ocular sheath, which forms a membranous lining, 
as it were, to the orbital canity, or bony box, which is anteriorly 
open, except when closed by the eyelids. 

Our design in the present chapter is to confine our considera- 
tion entirely to such portions of surgical ophthalmology as are 
likely to demand the careful and practical attention of the vet- 
erinarian. 



748 OPERATIONS UPON THE EYE AND EAR. 

A. — The Extraction of Foreign Bodies on the Surface 
OF THE Globe. 

The presence of a foreign body between the lids and the globe 
of the eye is just as painful to animals as to man, and may, if 
allowed to remain, give rise to symptoms of irritation and inflam- 
mation which, unless promptly relieved, may induce severe attacks 
of diseases which may compromise the usefulness of the organ. 

Dust, insects, and small seeds of various kinds may indeed 
find a lodgment in the eye, and resist the efforts made for their 
removal, notwithstanding the excited function of the membrana 
nictitans, or the super-excited flood of tears stimulated by their 
presence. 

Immediate removal is the first indication. This may some- 
times be effected by bringing the lids together and keej)ing them 
temporarily closed until the stimulated collection of tears washes 
out the offending substance. 

If this fails, cocaine must be applied upon the eye, and when 
its full effect is obtained, careful examination must be made, if 
necessary, with the assistance of a loup, by everting the lids, in 
order to bring the entire surface of the cornea into view The 
irritating body may be wiped out with the finger, a piece of cloth, 
or a soft camel hair brush, or when the object is hard and angu- 
lar, as a particle of metal or stone, which has become partly im- 
bedded in the cornea, the forceps may be necessary. 

B. — Puncture, or Paracentesis of the Cornea. 

The object of this operation is to empty the anterior chamber 
of the eye of its aqueous humor, of a collection of pus, or to effect 
a release of a living intruder from the cavity of the eye, as, for 
example, the parasitic ,/^Yar^a oculi. 

The operation is simjDle, but the use of cocaine cannot be 
omitted. The instruments necessary are a cataract knife, or a 
lanceolated bistoury (Fig. 539). It is introduced obliquely through 
the cornea, at a very short distance from the sclerotic, and its in- 



FiG. 539 —Lanceolated Bistoury. 



ON THE ESSENTIAL ORGANS OF SIGHT. 749 

troduction of course causes the immediate evacuation of the fluid 
contained in the anterior chamber, and the dropping or collapsing 
of the cornea, which assumes a rough and shrunken appearance. 
In a few hours, however, it resumes its normal condition, the 
secretion of the humor having taken place, and the wound of the 
cornea being closed. 

Compresses of cold water, and the application of a weak solu- 
tion of atropine will obviate severe symptoms. 

C. — Staphyloma. 

This designation applies to a deformity or distension of the 
cornea, consisting in its protrusion beyond its normal and sym- 
metrical convexity. It varies in shape, and may be round or 
pointed. It is very common in dogs, especially in young ones, 
and if not discovered and attended to in its first stage becomes 
very rebellious to treatment. If overlooked and neglected ulcera- 
tion of the cornea and destruction of the eye is certain. 

Cauterization, with nitrate of silver, the Hgature, and complete 
excision with the scissors are recommended, but the chances of 
success depend on the length of time it has existed and the size 
it has attained. 

D. — Cataract. 

The opacity of the crystalline lens, or that of its capsule, or 
that of the humor of Morgagni, or of these three conjointly, pro- 
duces loss of sight, and for its re-estabUshment the operation 
called "of the cataract" is, in some exceptional cases, attempted 
on horses and dogs. 

The object in view is the extraction of the opaque lens; its 
di\ision into fragments that may be resorbed ; or its dislocation 
from its normal position. It is not often performed in veterinary 
practice, but successful attempts have been credited to Vatel, La- 
fosse and others, while still others, as Gohier, Brogniez, H. Le- 
blanc, Haubner, Hertwig and Hering have reported their results 
as sometimes successful and sometimes otherwise. 

The animal is to be placed in the decubital position, and the 
dilatation of the pupil is to be obtained by the application of a 
solution of sulphate of atropia or extract of belladonna. 

Among the difficulties connected with this operation is the 
peculiar anatomy of the globe of the eye, which by the action of 



750 



OPERATIONS UPON THE EYE AND EAR. 



the posterior rectus muscle is drawn back in the orbital cavity, a 
displacement which not only renders the action of the instruments 
more difficult, but also stimulates the motion forward, over the 
cornea, of the membrana nictitans. The immobility of the eye is 
one of the first points to be secured. There are two ways of 
securing it, one fixing it from the front, the other from behind. 

It can also be fixed from the front in two ways — that of Le- 
blanc and that of Brogniez. Leblanc uses a tricuspid stylet (Fig. 
540), which has three branches, two of which are applied on the 




Fig. 540.— Tricuspid Stylet of Leblanc. 



sclerotic at the internal angle of the eye, the third, which is mov- 
able, resting also on the same membrane at its inferior part. The 
first two keeps the membrana nictitans from the cornea, and all 
three, implanted into the sclerotic, keep the globe immovable. 

Brogniez uses a special instrument, which he calls a " diapta- 
tor" (Fig. 541), which is a metallic rod, having three or four 




Pig. 341.— Brogniez Diaptator. 

points, twisted like those of a cork-screw, which by a sUght 
pressure, combined with a little twist of the instrument, com- 
pletely fixes the ocular globe. 

To fix the globe from behind, Hayne, Dieterichs, Prinz and 
Bleiweiss make an incision through the skin behind the orbital 
arch, and an assistant, with one of his fingers passed through it, 
keeps it in place by direct pressure. 

General anesthesia is always indicated. Peuch and Toussaint 
recommend the use of the Waldon forceps (Fig. 542) to immobil- 




'F»""'"""»"""""|'flM 



Fig. 548.— Forceps of Waldon. 



ON THE ESSENTIAX, ORGANS OF SIGHT. 



751 



ize the eye. It operates by grasping tlie conjunctiva on the inner 
angle of the organ, and keeping it motionless by a shght pres- 
sure. The Hds are kept widely separated by means of the specu- 
lum ocuh akeady mentioned. There are three principal modes of 
operation besides these, which are used in human surgery, which 
result in the union of these principal methods. 

1st. Method. Dislocation of the Lens. — It is intended to 
displace the cataract en masse from the pupilar focus, and to fix 
it in a dependent part of the chamber, behind the iris, where it 
will no longer intercept the light. 

It is generally performed in two ways — through a punctui-e of 
the sclerotic (Scleroticonyxis), or by puncture through the cornea 
(Keratonyxis). The instrument used is called Scarpa's needle 
(Fig. 543). This is either straight or curved. The eye being fixed, 



Fig. 543.— Scarpa's Needles. 



and the pupil dilated, the needle is introduced through the scle- 
rotic, on the outside, and lower part of the globe, a short distance 
back of the cornea (Fig. 544), pushing it in a direction first sUghtly 
obliquely upward, and then horizontally. The needle has thus 




Fig, 544.— Operation of Cataract by Displacement of the Lena. 



752 OPERATIONS UPON THE EYE AND EAE. 

penetrated between the ciliary processes and the border of the 
lens, and presently becomes visible to the operator, passing be- 
yond the internal border of the pupil. By a slight motion up- 
ward and downward, the capsule is then opened and the lens 
depressed, first backward, then vertically, and pushed downward 
into the lower part of the vitreous humor. A gentle rotation of 
the instrument then releases it from the substance of the lens, and 
it is returned to its horizontal position. The instrument is not 
withdrawn until it is ascertained that the lens is established in its 
new position. 

When the puncture is made through the cornea the entrance 
into the eye takes place near the center of this membrane, and 
the access to the lens takes place through the opening of the 
pupil. 

In either case the wound of the globe is insignificant. 

2d. Method. Extraction. — There are two principal modes of 
operation, one by extraction through a flap of the cornea upward, 
and another by a linear incision on the side of the globe. 

In the operation by the flap upioard, the knife of Richter, 
modified by Beer (Fig. 545), is introduced horizontally through 




Fig. 545.— Knife of Beers. 

the cornea, near the sclerotic border, a little above the horizontal 
diameter of the globe, with the edge turned upward, and as soon 
as the point of the instrument has entered the anterior chamber 
of the eye, it is pushed in a straight, horizontal direction, passing 
into the anterior chamber (Fig. 546), and when its point reaches 
the opposite side of the cornea, it is pushed through it in such 
a manner that its exit and its entrance occur at equal distances 
from the sclerotic border. 

The flap is completed by pushing the instrument directly out, 
when the aqueous humor escapes, and the cornea coUapses. 

The anterior wall of the crystalline cover is then divided with 
the kystitome (Fig. 547). The hook of which turns backward, 
and is made to tear the envelope by moving it from above down- 
ward and from within outward. The upper lid being raised with 
forceps, and a gentle pressure made with the finger at the lower 



ON THE ESSENTIAL ORGANS OF SIGHT. 
I 



753 




Fig. 546.— Operation of the Cataract toy Flap Upward. 




Fig. 547.— Kyetitome. 

border of the cornea, the lens presently falls out through the in- 
cision. If it becomes engaged in the wound it can be removed 
with the forceps or the curette of the kystitome. 

Unless care is taken at this point to avoid making too great a 
pressure upon the eye, there is danger of the escape of the vitreous 
humor. The Uds are then brought together and a light bandage 
applied, and as in other cases, the animal must be prevented from 
distvirbing the wound by rubbing or otherwise. 

The linear method consists in making a straight incision on 
the outside border of the cornea with the knife of Graafe (Fig. 
548). It is principally employed in cases of soft cataract. 



Fia. 548.— Knife of Graafe. 



754 OPERATIONS UPON THE ETE AND EAR. 

E. — Amputation or Extirpation of the Eye. 

This operation is only indicated in cases of degeneration of 
the globe, and after special traumatic lesions of the organ. It is 
comparatively a simple one, and not as dangerous nor as painful 
as it is generally supposed to be. It can easily be performed 
with a simple or a blunt bistoury. Hertwig recommends a sage- 
knife, and we have often performed it with only a pair of curved 
scissors. 

With the lids well separated, the eye, or what may remain of 
it, is secured with a pointed tenaculum, or a pair of forceps, and 
the conjunctiva divided in all its circumference with the knife. 
Then passing the bistoury into the orbital cavity, close to its 
walls, and cutting from the inside, and thence to the inferior part, 
the entire mass is detached, with the exception only of being held 
by the cord of the optic nerve. 

This last attachment is then severed with the scissors. The 
hemorrhage which always accompanies the operation is readily 
subdued by pressure. Simple cleanliness is all that is required in 
the subsequent treatment. 

Doctor E. Eolland describes his tnodus operandi for the enu- 
cleation of the eye as follows: The operation requires a specu- 
lum oculi, a hook such as is used in the operation for strabismus, 
curved blant scissors, forceps to fix the eye, and a pair of scissors 
curved on their flat for the section of the optic nerve. 

The lids being held apart with the speculum the operator 
grasps a fold of the conjunctiva, on the outside of the eye, and 
shts it near the border of the cornea. Then, with the scissors, 
the conjunctiva is entirely divided round its margin, near the 
corneal border. The sub-conjunctival cellular tissue being after- 
ward divided with the scissors, the muscles are brought out with 
the strabismus hook and divided, beginning with the external 
rectus. The speculum is then removed, and by pressing firmly on 
both Hds, the globe of the eye is pushed out of the orbital cavity. 
The curved scissors are passed behind the globe, and the optic 
nerve amputated at its point of entrance into the globe. 

The operation ended, the orbital cavity is washed out with cold 
sterilized water, and is then filled with pulverized and sifted bor- 
acic acid. This dressing is removed daily for five or six days, and 
the eye protected as in Fig. 549. 



ON THE ESSENTIAL ORGANS OF SIGHT. 



755 




Fig. 549.— How to Protect the Eye. 

Ocular Peothesis. 

The animal which has undergone the preceding operation is 
considerably deformed, but the difficulty is easily remedied by the 
insertion of an artificial eye. 

Artificial eyes for horses were first introduced by Schmidt in 
1850. They were originally made of glass, but many varieties of 
material have since been used, and to-day all instrument-makers 
probably keep them in stock, of hard rubber and gutta-percha, 
etc. By the skillful use of pigments the artificial organ can now 
be made to so closely match its Hving companion as to be undis- 
tinguishable from that which the animal has always carried (Figs. 
550 and 551). 

But the artificial organ must not be introduced into the orbital 





Figs. 550, 551.— Artificial Eye— side and full view. 



756 OPERATIONS UPON THE EYE AND EAR. 

cavity until all granulations, suppuration and inflammatory proc- 
esses in and about the wound have ceased. 

To put the artificial eye in place the upper lid is raised and the 
the border of the artificial organ placed underneath it; in the 
meanwhile the lower lid is drawn downward and the correspond- 
ing border of the eye pushed on its internal face. The eye is in 
place, especially if after its introduction the animal makes a few 
motions with his lids, all the folds of which are soon removed. 
To remove the eye the lower lid is drawn downward, and it is dis- 
lodged by passing a blunt probe under it toward its posterior face. 
The artificial eye will not need removal of tener than once in eight 
or ten days. If worn too long there might be danger, with cer- 
tain materials, of softening. The advantage of having an alter- 
nate eye will, upon reflection, become obvious. 

ON THE EAR 

Amputation. 

Usually, only horses and dogs are subjected to this opera- 
tion. 

With the horse, the object is commonly either the correction 
of a deformity, or the cure of disease or injury. 

When performed upon the dog, it is principally as an opera- 
tion of fashion — so-called — or in compliance with some prevalent 
caprice relating to a supposed improvement in the appearance of 
the animal. Yet with these it must at times, of course, become 
necessary for the repair of an accident. It should be understood 
that the seat of the operation is in all cases the cartilage of the 
concha. 

Amputation in Horses. — The amputation may be either partial 
or complete. One ear may exceed the other in size, and it may 
become necessary to trim down the larger for the sake of estab- 
lishing symmetry between the mismatched pair with the knife. 
Or both may be similarly misshapen, and a partial amputation of 
both may be, therefore, indicated, for the same aesthetic reason as 
that which influenced ia the other case. 

This operation is seldom, if ever, performed at the present 
time. The complete amputation is indicated in cases where the 
cartilage is affected with pathological degenerations, and especially 
when these exist toward its base. 



AMPUTATION OF THE EAR. 



757 



Partial amputation may be performed with the patient in 
any postiu'e, and may be considerably simpHfied by using Brog- 




3£ T 

Figs. 552, 553.— Brognlez Apparatus for Amputation 
of the Zar. 



Fig. 554.— Apparatus of Brog- 
nlez in Position. 



niez's apparatus. This consists of a wooden model of the inside 
of the cartilage (Fig, 552), and of metallic en- 
velopes or patterns of the outside (Fig. 553) of 
which there should be separate ones for each 
ear. Both the wooden model and the metallic 
pattern are held in place by a systematic screw 
(or wood screw) like those usen by cabinet-ma- 
kers in gluing wooden joints together. The ap- 
paratus is adjusted as shown in Fig. 554, and 
the excision of the protruding cartilage is made 
with the bistoury. 

Amputation with the nippers of Garsault 
(Fig. 555), or that with the bistoury do not give 
equally satisfactory results. 

Complete amputation, according to Peuch 
and Toussaint, is best performed with the ani- 
mal under complete anesthesia. We have had 
opportunities of operating without it, but it 
cannot be questioned that it furnishes power- 
ful assistance, when it becomes necessary to 
keep the head in place, as in this case. ^^''- ®S^7bS®™ *" 




758 OPEEATIONS UPON THE EYE AND EAR. 

We consider the operation to be comparatively a simple one, 
though deUcate handling is required. 

A convex bistoury or scalpel, dissecting and artery forceps and 
needles and thread are the instruments required. 

A circular incision is made always, if possible, by one stroke 
of the knife, toward the base of the cartilage, beginning at about 
the lower commissure of the external opening of the concha; then 
carefully avoiding the division of the bifurcation of the parotid 
gland, the insertion of the muscles attached upon the concha is 
divided, the posterior and anterior auricular arteries are ligated, 
the adhesions with the surrounding cellular tissue are lacerated 
with the handle of the scalpel, and the Hgament which tmites the 
concha to the annular cartilage is severed, the Httle prolongation 
of the former can then be easily followed to its end, and the con- 
cha be readily extirpated by lacerating its cellular attachments. 

The wound is closed with sutures, and treated in the usual 
way. 

Amputation in Dogs. — Although, as we have remarked, this is 
principally an operation of fashion, there are still conditions in 
which it is rationally indicated. It is commonly performed with 
scissors, curved or straight, with which the requii'ed portions of the 
concha are amputated by a single cut of the instrument. 

Instruments have been invented to insure a more certain suc- 
cess in the operation, and a neater finish after the wounds have 




Fig. 556.— Nippers to Amputate Dogs' Ears, 

healed. The limitation forceps, represented in Figure 556, pos- 
sess some advantages in these respects. 

In any mode of operation, the flap of skin first excised be- 
comes the only true pattern by which to shape the second. 

The operation is generally followed by some hemorrhage, but 
this either subsides spontaneously, or by the application of local 
hemostatics, and the cicatrization proceeds without help under 
the scab, which after a day or two covers the edges of the wound. 



CHAPTEK XV. 
DISEASES OF THE WITHERS. 

The withers is the region of the body which, of all others, is 
most exposed to lesion, the injuries to which it is subject being of 
every form, nature and degree of severity. From its very loca- 
tion it is especially liable to all kinds of external traumatisms, and 
is pecuHarly apt to suffer from blows, bruises, bites, contusions, 
pressures and frictions by the harness, etc., and these give origin 
to bloody or serous tumors ; cold and warm oedemas, abscesses 
superficial or deep, and various wounds of the surface, with or 
without injuries of the subjacent tissues; and these again may be 
followed by necrosis of the dorso-cervical ligament, and of the 
apex of the dorsal vertebrae, accompanied with purulent filtrations, 
in various localities, the formation of fistulous tracts, and possibly 
the extenston of the diseased conditions to the ligamentum nuchse, 
ending with the disease of the neck, with aU its unfortunate 
sequelae. 

With the consideration of such a multipHcity of pathological 
evils before us, an orderly and systematic arrangement of topics 
is especially necessary, and we shall, therefore, in our treatment 
of the diseases of the withers, adopt the classification of Bouley 
^d Nocard. And this introduces us successively to the study 
of excoriations, cedemas, hetnatoma, core or stickfasts, cysts, 
abscesses, wounds, and the "diseased toithers^^ proper, or what is 
generally understood as "the persisting lesion, fistulous in its 
character, and whose condition of formation and duration is 
due to the mortification of the fibrous, yellow or cartilaginous 
tissue of the apex of the spinous processes of the anterior dorsal 
vertebrae." 

Considered from an anatomical point of view, the withers form 
a very complex region. Its skeleton is formed by the superior 
spinous processes of the anterior dorsal vertebrae, and it is sur- 
rounded by muscles arranged in layers, intersected by fibrous 



760 



DISEASES OF THE WITHERS. 



aponeurotic bands or sheaths. The vertebrae give attachment 
by the cartilaginous nucleus, which is at their apex, to the pos- 
terior portion of the yellow, elastic cord, which is part of the 
funicular portion of the Hgamentum nuchse, and are also united by 
the interspinal ligament. The muscles which rest upon the ver- 
tebrae form six different planes, thus divided : 1st. The sMn, lined 
inside by cellular tissue, more condensed toward the median line 
than on the sides, where it is loose ; 2d. The trapezium muscle, 
thin and aponeurotic inferiorly, but thicker in its upper portion, 




Ccl 



Fig. 557.— 1st and 2d Layers of the Eegion of the Withers. 
P.— Skin folded down, pf.— Funicular portion of the cervical ligament, tc.— Cer- 
vical portion of the trapezium, td. — Dorsal portion of the same. ea. — ^Acromion spine 

which is muscular (Fig. 557), and lying over the external surface 
of the scapula and its cartilage of prolongation. 3d. The rhom- 
boideus muscle, which is separated from the second plane on its 
external surface by a layer of loose cellular tissue (Fig. 558), and 
is lined in its internal face, by a yellow elastic band, inserted on 
the inside face of the cartilage of prolongation of the scapula. 



DISEASES OF THE WITHEES. 



761 




Fig. 558.-3(1 Layer of the Eeglon of the Withers, 
ch. — Cartilage of the scapula, pf. — Funicular portion of the cervical ligament, 
rh. — Rhomboideus muscle, a.— Angularis of the scapulae. S. — Splenius. 




Fm 559.— 4th Layer of the Withera, 
BC— Section of the scapula and surrounding muscles, da. — Anterior small serratus. 
ap. — Its aponeurosis, gd.— Great serratus. pf. — Funicular portion of the cervical lig- 
ament, s. — Inferior attachment of the splenius. ad.— Ramifications of the dorsal 
artery, gc— Great complexus. pc— Small complexus. a.— Section of the angularis 
scapulse. 



762 DISEASES OF THE WITHERS, 

This band is specially liable to attacks of necrosis. 4th. The su- 
perior portion of the anterior small serratus muscle, which is 
formed by a broad aponeurosis, attached to the superior extrem- 
ity of the spinous processes of the vertebrae (Fig. 559). 5th. The 




Fig. 560.— 5th Layer of the Withers, 
pi. — Lamellar portion of the cervical ligament, pf. — Funicular portion of the same, 
ac— Superior cervical artery, te. — Transversal spinous of the neck. bs. — Superior 
branch of the spinalis, bl. — Inferior branch of the same muscle, ic— Common inter- 
costal, ad. — Dorsal artery, gd. — Great serratus. si. — Inferior scalenus, it. — Inter- 
transversalis muscle. 

anterior portion of the ilio-spinalis muscle (Fig. 560). The 6th 
and the deepest of these planes, resting on the faces of the long 
spinous processes of the vertebrse, is formed by the transverse 
spinal muscle of the back. (Fig. 561). To these are to be added 
the posterior extremities of some of the muscles of the neck, 
covered by the internal face of the scapula, the ramification of 
the large blood vessels, branches of the anterior aorta, and the 
dorsal and superior cervical artery with the spinal nerves which 
are distributed in that portion of the body. If we map aU this 
distinctly in our minds, we shall have the material for forming an 
idea of the structure of the withers, and the intricate and inter- 
esting arrangement and disposition of its many parts, with their 
relation to the ailments which attack them. This wUl be facilitated 
by an inspection of the illustration (Fig. 562), representing a 
transverse section of the entire region involved. The drawing 
exhibits the obliquity of the direction of the various muscular 
layers, and demonstrates the tendency of the purulent gatherings, 
by gravitating and collecting between them, to contribute to the 



DISEASES OF THE WITHERS. 



763 



r- te jf ac i tc 




Fig. 561.— 6th Layer of the Withers. 
pi.— Lamellar portion of the cervical ligament, pf.— Funicular portion, te.— Trans- 
verse spinalis of the neck, ac— Spinous processes of the dorsal vertebrae, t.— Tuber- 
te.— Transverse spinalis of the back, ie.— Common intercostal, 
it,— Inter-transversalis. i.— Externai intercostal mus- 



csities of the same 

c. — Kibs. gd.— Great serratus. 

cle. l.—Inter-spinalis ligament. 



formation of the ailment recognized as a true " diseased withers," 
with the habitual severity which is its characteristic. 

The originating causes of the diseases of the withers may be 
divided into the predisjyosing and the occasional. Among the 
first are to be noted a defective anatomical conformation of the 
region ; the kind of work performed by the animal, and the degree 
of care he receives. For example, when the withers are low, thick 
and fleshy, as in heavy draught horses, the saddle of the harness 
has a tendency to slip forward and cause chafing and excoriation, 
an accident from which, however, animals with high, sharp withers 
are by no means exempt ; for though, for the reason stated, they 
are less liable than those of the other conformation, the advantage 
is ofi'set by the fact that the skin is exposed to a more unequal 
pressure, especially if that part of the harness is not properly 
padded and fitted, and presses irregularly on the soft tissues, 
upon which it rests. 



764 



DISEASES OF THE WITHEES. 




Fig. 562.— Transverse Section of the Eegion of the Withers, 
p.— Skin. fe. — Fibre elastic tissue. t.^Dorsal trapezium, r.— Rhomboid muscle, 
cp.— Cartilage of the scapula, is.— Ilio spinalis, v.— 5th dorsal vertebra, gd.— Great 
serratus. ss. — Sub-scapularis. s. — Scapula, se. — Antea-splnatus. sh.— Scapulo- 
humeral joint, pf.— Deep pectoral. pt.—Thoraciq walls. 

Saddle horses are for tlie same reason peculiarly apt to become 
sufferers from the lesion of which we are speaking. The self- 
inflicted bites and the scratching and rubbing of animals suffering 
from parasitic affections, in their efforts to relieve themselves, may 
also result in placing them in the category of the predisposed. 

To enumerate all the occasional causes would be to make a 
catalogue of casualties, which would be best done by coj)ying from 
the accident columns of the daily press, and we shall merely refer 
to a few of a kind which may possess some special characters and 
notable features, not too obvious or common and familiar 

Contusions of any kind, resulting from the causes stated, or 
even little abrasions from the simple misfit of a blanket kept in 
place by a surcingle too tightly buckled — anything, in fact, which 
may give rise either by its immediate effect or by its continuance, 



DISEASES OF THE WITHERS. 765 

to the slightest form of pathological change, may serve as a spark 
which may kindle into the most serious case of fistulous, diseased 
withers. 

(a) JExeoriation. — This is the simplest of the lesions of the skin 
covering the withers, or any portion of the body. It is most com- 
mon in summer, when it appears in the form of a red spot, becom- 
ing rapidly covered with an abundant serous exudation, which 
rapidly forms a yellow or brownish crust, adherent to the under- 
lying tissues. This is always painful, especially in summer, when 
it excites a violent pruritis, which may degenerate into a lesion 
of a serious nature. 

Excoriations, however simple, ought never to be neglected, and 
precautions should always be taken against them. When they do 
occur, local heahng applications, usually simple ones, are sufficient, 
and should be made without delay. 

{!)) Warm (Edema. — This is the resvilt of the laceration of 
the subcutaneous cellular tissue and its subsequent inflammation. 
Saddle horses suffer from it, especially in summer and after long 
journeys. At such times, the skin becoming more or less adher- 
ent to the saddle, the motion of the animal, together with that 
of the skin, is communicated with every step to the subjacent 
cellular tissue (a sort of rubbing, to-and-fro motion) ; and this vio- 
lence, though slight, produces by its long continuance the natural 
effect of inducing an inflammatory state in the tissue. This 
oedema is characterized by a tumefaction of the parts, warm and 
pitting under pressure, more or less painful, and having a tendency 
to spread toward dependent structures. It disappears by resorp- 
tion in two or three days, but leaves a slight thickening of the 
cellular tissue, sometimes difficult to detect. This resorption 
takes place if the originating cause has, within a moderate period, 
ceased to operate ; but if, on the contrary, it has been permitted 
to keep up its irritating action, the oedema will increase, and in 
due time the condition will be changed to that of supjDuration, — a 
termination to be, if possible, by all means anticipated and pre- 
vented. 

The removal of the cause, sometimes accomphshed hy merely 
giving the patient a season of rest, is the most important item in 
the treatment. The resorption of the oedema can be accelerated 
by means of massage, cold compresses, astringent lotions, weak 
stimulating frictions of an alcoholic nature, or cold irrigations. 



766 DISEASES OF THE WITHEBS. 

{c) Hematoma, or Bloody Tum,or. — This lesion is produced 
by a violent traumatism, such as a blow, a contusion, or a violent 
bite by some other animal. It develops immediately upon the oc- 
currence of the cause, resulting from the laceration of the super- 
ficial blood vessels. It is characterized by a swelling, varying in 
size according to the nature of the producing cause. It is at first 
somewhat warm and fluctuating, then becoming puffy, and when 
the blood has coagulated, hard, tense and crepitating. Ordinarily 
it is not very warm or painful, but it becomes so after a few hours, 
and then there is danger of its assuming a suppurative character. 
Yet in other cases it may maintain that condition for two or three 
weeks, undergoing the process of resolution, the resorption usually 
becoming complete in that period. The correct diagnosis of this 
condition, and of any occurrent changes, some of which it is im- 
portant to know, can be more satisfactorily estabhshed by explor- 
ation. 

Left without interference and in the absence of irritating causes, 
the hematoma will usually subside by spontaneous action. In their 
treatment, cold applications are indicated during the first days of 
its existence, but at a later period, when the tumefaction has be- 
come of a denser consistency, absorbent and stimulating local 
medication is indicated, such as blisters of cantharides, or of mer- 
curial preparations, or of the iodine compounds. These applica- 
tions, however, must not be too hastily resorted to, lest the exces- 
sive or premature stimulation should end in the formation of 
abscesses. Except when there is positive evidence of suppuration, 
pressure by bandaging and the opening of the tumor with the 
bistoury are always contra-indicated. 

(c?) Core, or Stickfast. — This is caused by the immediate 
mortification of a portion of the skin, and often of the deeper 
tissues. It is a hairless scab of a blackish color, having the ajD- 
pearance of tanned leather. It is at times superficial, and has a 
tendency to extend to the subjacent structures. It is rigid and 
inflexible, and its pressure upon the deeper tissues tends to in- 
crease mortification. The tissues surrounding it are inflamed and 
their sensibility increased, and at a later period a process of elim- 
ination by suppuration takes place all around its edges. But this 
pus does not very readily escape, and there is always a portion 
remaining in the bottom of the sloughing sui'face which becomes 
fistulated with the formation of collections. If the core should 



DISEASES OF THE WITHERS. 767 

extend to the dorsal ligament or to the bones, the result will be 
necrosis and caries, and a true diseased ioither will be the conse- 
quence. With these conditions, lymphangitis, leucophlegmasia, 
and deep abscesses may be expected, and usually supervene. 

The sloughing of the mortified structure is always slow, espe- 
cially when the deeper tissues are involved, but the wound which 
remains after the casting off of the core is not uniform in its sub- 
sequent action. When it is superficial it heals quite rapidly, but 
recovers only with great dif&culty when it is deep-seated, and in- 
volves fibrous, cartilaginous and bony structures. 

The prognosis of this lesion of the withers varies according to 
the thickness of the tissues which are involved ; but it also varies 
according to its location, those which are situated on the lateral 
faces of the withers being less serious than those which occur on 
the median line. 

The treatment indicated is strictly local. The first indication 
is to discontinue, or obviate, the irritating cause, by changing 
the harness, by chambering it, or, what is better, by refraining 
from working the animal until he has entirely recovered. The 
second indication is to hasten the sloughing of the mortified tis- 
sue, and allay the irritability which the animal betrays upon the 
slightest touch of the hand, or other object, upon his back. Top- 
ical remedies in the form of ointments, lotions or povdtices, are in- 
dicated for this purpose. As soon as the process of sloughing 
begins it must be stimulated and encouraged. Warm comjjresses, 
antiseptic lotions, glycerine, phenial mixtures are then beneficial. 
The maintenance of simple moisture, by means of phenicated or 
creolined mixtures has, in our own experience, been of great ad- 
vantage. If during the process of the elimination of the core the 
suppuration seems to be abundant with a tendency to accumulate 
instead of escaping, care must be taken to facihtate its removal 
by means of oakum, absorbing cotton, sponges or drainage 
tubes. Sometimes the core is of unusual size, with roots reaching 
deeply into the tissues beneath, but although this may be the 
case, no attempt should ever be made to tear them forcibly away. 
They must be permitted to drop away by spontaneous action. If 
the edges are very wide they may be trimmed off with the scissors 
or bistoury, but interference beyond this is never permissible. 
When they have entirely sloughed away there remains but a simple 
granulating wound, which ordinarily requires but mild forms of 



768 DISEASES OF THE WITHERS. 

treatment. The animal, however, ought not to be made to re- 
sume work until it is entirely healed. 

(e) Cyst, or Hygroma. — These terms designate a tumor which 
usually forms on either the middle or the lateral face of the 
withers, originating in the dropsical condition of a serous bursa. 
On whatever part of the withers it may make its appearance, the 
originating cause is the same, and it is the effect of friction, or of 
the slight but long-continued irritation produced by an ill-fitting 
harness, inflicted while the animal is suffering from parasitic dis- 
eases. In these cases the connective areolae of the bursa become 
the seat of an amount of secretion in excess of that which is re- 
moved by the act of resorption, and the accumulated hyper- 
secreted fluid gathers into the cavity, to form the serous cyst. 

When located in the median line, the hygroma constitutes a 
soft tumor, of varying size, from that of a pigeon's egg to that of 
a child's head — bilobulated, always soft, fluctuating, without heat, 
and painless ; even transparent, when the skin is pigmentless. It 
always presents the differential characters of being well defined 
in its outlines, and without inflammatory peripherical infiltra- 
tion. 

When the cyst is on the side of the withers it may present 
some similar characters, but when it is deep, under the apone- 
urosis of the trapezium, or even under the rhomboideus, an ex- 
ploration becomes necessary to establish the differential diagnosis 
from abscess, as upon the true nature of the tumor depends the 
immediate indications of treatment. 

Hygroma of the withers may retain their characteristics for a 
long time, but many change iu their nature under the influence 
of external irritations, bruises, contusions, improper treatment, 
etc. In that case the cyst is transformed into an abscess, or rather 
a suppurating cyst. 

In respect to the treatment of cystic withers, the first indica- 
tion is to remove the cause, and with this not only will the accu- 
mulation of the serosity cease, but the possibility of its trans- 
formation into the abscess form will be removed. 

When the cyst is small and of recent formation, resolvent 
treatment is in order, as cantharides ointment, bichloride or 
biniodide of mercury pomatums, etc. Actual cauterization, in lines 
or in points, has given satisfactory results in chronic cases. In- 
jections of tincture of iodine have also been recommended. Our 



DISEASES OF THE WITHERS. 769 

own experience warns us that it is not without danger, from its 
liability to be followed by a severe form of diseased withei's. 
Bouley and Nocard, in relation to this mode of treatment, say "it 
is better to empty the cyst with a capilliary trocar, or by the 
aspirator, to wash its cavity with an antiseptic preparation, shghtly 
irritating (5 per cent, solution of phenic acid), to repeat this injec- 
tion several times, until the liquid taken out of the cyst is per- 
fectly limpid, and then apply over the entire surface of the skin a 
thick coat of blister." 

The purulent cyst is treated as an abscess. 

if) A bscess. — A phlegmon of the withers may rise suddenly 
under the influence of a severe traumatism, or become the sequel 
of a hematoma, or of a cyst. It appears most commonly on the 
superior part of the withers ; sometimes on the sides, as a tumor 
more or less warm and painful, first uniformly hard and tense, 
and afterward soft, with a fluctuating center, and surrounded by 
an oedematous infiltration, more or less developed. If the abscess 
is superficial, ulceration of the skin soon takes place, followed by 
the escape of thick, white and creamy pus. 

If, on the contrary (and this is often the case), the abscess 
is deep, developing itself under the the aponeurosis of the great 
dorsal, or of the rhomboideus muscle, or even deeper, under the 
cartilage of the scapula, or the thickness of the ilio-spinalis, the 
symptoms then, however, being less defined. The tumefaction is 
less characteristic, the heat less marked, the fluctuation not detect- 
able, and the only sign which guides the surgeon is the excessive pain 
manifested uj)on the slightest pressure on the tumor, and from 
which the animal shrinks in fear. This soreness is in fact so great 
that in some animals it interferes with the action of the leg on the 
side affected. The appearance of general febrile symptoms is not 
uncommon at this period, with elevation of temperature, increase 
in the circulation, anorexia, excessive thirst, etc. At this period, 
also, it becomes important to be certain of the diagnosis, or at 
least to be sure of the existence of the suppuration, and its loca- 
tion must be accurately made out, in order to prevent the severe 
disorders that may be caused by the presence of the pus ; a prob- 
lem which can be only solved by repeated capillary exploring 
punctures, made at various points, and at given depths, according 
to the dimensions of the phlegmonous enlargement. 

The prognosis of abscess of the withers depends altogether on 



770 DISEASES OF THE WITHEES. 

the seat it occupies. If superficial, and on the lateral faces of the 
region, it is not serious, If on the median line, it assumes a more 
severe character. If deep, it is also of a dangerous nature, unless 
it is simple or Hmited ; but, on the contrary, if the quantity of the 
pus has continued to increase, and infiltration has taken place into 
the cellular tissue separating the muscular layers ; or the sup- 
puration has penetrated under the cartilage of the scapula; it 
will have assumed the most complicated form of the disease, with 
chances of recovery of a very doubtful character. When the pres- 
ence of the pus has been detected, the immediate indication is to 
assist its discharge by a free incision down to the bottom of the 
cavity. The incision must be made on the most dependent part 
of the tumor ; in such manner as to prevent the collection from 
settling in a cul-de-sac. A means of drainage must be provided, 
and the tube is preferred to the tent of oakum, or even to the 
seton, as more sure to reach all parts of the collection, and the 
more thoroughly to wash out the cavity. 

If, however, the sujDpuration has not been detected, the appli- 
cation of local stimulation is indicated by means of warm com- 
presses, hot poultices and the like ; a constant watchfulness being 
maintained, meanwhile, in order to detect the presence of the pus 
at the earhest moment of its formation ; when it must be immedi- 
ately evacuated. 

{g) Wounds. — Resulting from every variety of traumatic 
agencies, these injuries will necessarily vary in their extent and 
the nature of the tissues which are involved. 

They therefore extend from the most trifling hurt of the skin 
to the severest lacerations of the important ligamentous, cartila- 
ginous and bony structures contained in the region under con- 
sideration. With such a diversity in their form and nature there 
must also be a corresponding range in the character of the prog- 
nosis to be announced, from that of rapid spontaneous recovery, 
without interference, to the gravest of terminations. 

One of the principal indications in the treatment of wounds of 
the withers is to prevent as much as possible the filtration and 
deposit of pus through the various layers of the region, and facili- 
tate the cicatrization, by placing them in a state of immobility, 
and according to Bouley and Nocard, the best method of seciiring 
this suspension of movement is to apply a broad blister all around 
the wound, and to repeat the appHcation after a few days. The 



DISEASES OF THE WITHEKS. 771 

pain caused by this compels the animal to abstain from all move- 
ment, and besides this the inflammatory swelling resulting from 
the bUster promotes the cicatrizing process by stimulating the 
proliferation of the cells of the repairing tissue. Aside from this 
special direction, the treatment of wounds of the withers involves 
no methods or indications different from those of similar hurts in 
other parts of the body. In most cases the surgeon must trust 
his experience and knowledge of general principles for guidance. 

(A) '■'■ Diseased 'Withers'''' proper : Fistulous Withers. — As we 
have before stated, this denomination belongs to "a persisting 
lesion, fistulous in character, due to the mortification of the tis- 
sues of the withers, fibrous, yellow, cartilaginous or bony." It is 
necrotic in its nature, and while it may attack but one, it may 
also exist in all of these organs. 

Whatever this condition may be, however, the necrosis is always 
manifested externally by an indicator, in the form of a fistula giv- 
ing exit to an abundant, thin pus, serous, sanious, grayish in color, 
adhering to the hair, and irritating and excoriating the skin upon 
which it flows. At first it is odorless, and nearly homogeneous, 
but it soon becomes foetid in odor and loaded with the detritus of 
necrotic tissues, more or less abundant, varying in thickness and 
in color, according to the nature of the tissue from which it is 
formed. 

One or several of these fistulous openings may exist on one or 
both sides of the withers leading from the same or from different 
necrotic centers. Their number is not limited. Several of them 
may be in existence at the same time, especially when the disease 
has maintained its hold on the system for a period of three or 
four months without being checked or cured ; a state of things 
not infrequently witnessed. 

Their formation is explained by the constant accumulation of 
the pus in the sinuosities of the original tract, which by degrees 
overcomes the resistance of the surrounding structures, and es- 
tablishes a channel for itself by the same process as that by 
which the first outlet was formed. It may sometimes happen that 
the opening of new canals becomes the cause of the closure, or 
perhaps only the constriction, of the original channel, and a new 
exploration becomes necessary to ascertain the new routes of the 
fluid. In this case their direction will be best made out by the 
injection of liquids through their open mouths. 



772 DISEASES OF THE WITHERS. 

The presence of one of these canals at the bottom of a wound 
may sometimes be detected by the appearance of large, fleshy, 
cone-shaped granulations, of a purplish color, from which an ooz- 
ing of pus takes place upon the application of pressure. 

But in another case, the orifice of the fistula may be directly 
on the skin, surrounded with granulations, protruding, soft and 
bleeding upon the sHghtest touch, with an escape of sanious pus 
between them ; these granulations at a later period, flattening, as 
the wound contracts, until the thinned skin seems to be continu- 
ous with the smooth, reddish membrane which lines the internal 
face of the tract. It may even happen that a process of cicatriza- 
tion taking place around the opening will transform its external 
outlet into a narrow strait which opens in the bottom of a cavity 
formed by the skin drawn inwardly by the cicatricial retraction of 
the indurated peri-fistulous tissue. 

The direct exploration of the fistula is the best mode of ascer- 
taining its existence, direction, extent and depth, and also the 
lesion which gives rise to it. This exploration ought to be made 
by the taxis, since it is obvious that no instrument can communi- 
cate an impression such as can be obtained by the touch of the 
finger. By the hand, therefore, must be ascertained the course 
and sinuosities of the fistula, its diverticulum, the nature of the 
necrosed tissue, and the extent of the mortification. But this 
manual exploration is not always possible, either because of the 
deficient caliber of the passage, or of its sinuosity, or its length. 
Eesort must be had to the various probes and directors in use. 

When the necrosis occupies the apex of one or more of the 
spinous processes, and the fistula is superficial, a slight incision 
will expose the diseased spot to ocular inspection, and the condi- 
tion of things may be at once fully reaHzed. When the lesion is 
limited to the cervical ligament, the eschar or slough will have 
an olive-greenish color, and will be of soft, pultaceous consistency, 
with a pecTiliar foetid odor, from its maceration in the pus. If 
the necrosis has attacked the cartilages of the vertebrae, the morti- 
fied part assumes a yellow color, with a tint of pale green. In 
all cases, however, it is more or less loosened at its borders, and 
differs materially from that of the healthy tissue. And while at 
the point of separation it is covered with a layer of granulations, 
highly vascular, yet the continuity of the fibres between the 
healthy and the diseased tissues still exists in the parts which are 



DISEASES OF THE WITHEBS. 773 

deeper and more central, where the connection is maintained by a 
sort of peduncle of varying size, through which the necrosis con- 
tinues to be propagated. If the disease is of sufficiently long 
standing the necrosis may involve the entire thickness of the carti- 
lage, lu this case the spongy tissue of the vertebrae is exposed, 
covered with the healthy granulations, which contribute to the cic- 
atrization. This, however, is a rare termination, the bone, ordi- 
narily, becoming necrosed or carious, the necrosis being indicated 
by its brownish color, its di-yness, its roughness and its sonority 
on percussion, while the caries is recognized by its friabihty, its 
red and yellowish color, the foetid suppuration which oozes from 
its areola and the facihty with which it yields to the edge of a 
sharp cutting instrument. 

This condition of mortification may affect but a single verte- 
bra, but it is not uncommon to find several, or possibly all, the 
spinous processes of the region affected. 

While the fistula may be considered as the essential physical 
symptom of this ailment there are other symptoms coexisting. 
There is accompanying it an external swelling, sometimes diffuse, 
sometimes compact, and more or less indurated, according to the 
duration of its existence ; very painful on pressure, and of which 
the form, direction and extent so perfectly correspond with those 
of the fistula, that it may be viewed as accurately representing 
the extent and limits of the lesion itself. 

This induration increases in consistency, and may with time 
become infiltrated with calcareous deposits, or even bony growths, 
attached to the spinous processes. 

The diagnostic and prognostical importance of this induration 
is very great. So long as there is no perceptible decrease in its 
dimensions, no apparent improvement in the external wound or 
modification in the nature and amount of the discharge can be of 
any favorable signification, and the surgeon may feel thoroughly 
assured that the disease continues unchanged in extent and char- 
acter. As it diminishes it indicates that the necrosis is also con- 
tracting its limits, and it becomes certain that the sloughing has 
taken place and the wound is once again assuming its character 
of original simplicity. And when the swelling disappears, and 
the tissues have resumed their normal integrity, questions as to 
the depth of the fistula, or the extent of its sinuosities, and abun- 
dance of the discharge will cease to be of any significance. 



774 DISEASES OF THE WITHERS. 

In the beginning of the necrosis, while the parts are very 
sensitive, the exaggerated sensibility is not at aU in proportion to 
the apparent extent of the disease. The animal shrinks from the 
manipulations of the touch, and this is a symptom which should 
be carefully considered in its relation to the progress of the dis- 
ease, fi'om the fact that in these manifestations it is passing 
through the same phases as those which marked the progress 
of the induration, running a sort of parallel with the duration 
of the necrosis, and diminishing as the sloughing proceeds, the 
interior situation being interpreted by the exterior phenomena, 
with some exceptions For there are cases in which it diminishes, 
while the disease continues without change, to exhibit the same 
severe symptoms. One effect of the abundant suppiiration accom- 
panying diseased withers, and the febrile symptoms which accom- 
pany it, is a rapid loss of Hesh by the suffering animal. 

The disease is always of long duration, and even when treated 
in the most rational manner. Its persistency will naturally cor- 
respond with the slow process of the sloughs and repairs of the 
tissues involved, themselves of comparatively low vitality and 
slow of change. But as soon as the separation of the diseased 
parts has taken place, however deep the wound may have been, 
or whatever the number and depth of the fistulse, the cicatriza- 
tion proceeds rapidly, and is completed in a comparatively short 
time. The terminations, which are to be looked for, are classified 
by Bouley and Xocard under the following heads : 

1st. Resolution. — This is very rare if the disease has been 
neglected, and only occiu's when it has been of a circumscribed 
extent and seated in a region favorably situated for the elimin- 
ation of the mortified tissue, as when it escapes through large 
openings, without lying long enough in the midst of the muscular 
substance to produce the effects of the long confinement of the 
pus in the deeply situated regions. 

2d. Disease of the neck, when the necrosis has spread as far 
forward as the cervical portion of the ligamentum nuchae. This 
forms the more common termination, and is as serious and fatal 
as the original disease itself. It is too often met with, especially 
in low-bred animals of lymphatic constitution. 

3d. Death, too frequently. 

4th. Putrid infection, due to purulent fermentation and the 
absorption of septic principles. 



DISEASES OF THE WITHERS. 775 

5th. Purulent infection^ i. e., consecutive with the caries of the 
vertebrae and with the phlebitis of the veins of the region. 

6th. Purulent pleurisy, resulting from the passage of the pus 
into the thoracic cavity through the intercostal muscles. 

7th. Exhaustion, in consequence of the uncompensated loss 
of substance by the abundant continued suppuration, and its ac- 
companying severe and persistent fever. 

Fistulous withers is always a serious disease, not only because 
of its progressive tendency, but also because, however intelligent 
and proper may be the treatment it receives, it can never be relied 
on to prevent the spreading of the necrosis, and assure a healthy 
cicatrization. The degrees of severity nevertheless vary, accord- 
ing to circumstances. It is less serious when the necrosis is on 
the median line, and the prognosis is still more favorable when it 
is on the posterior part of the region. When situated forward it 
seems more tenacious, and the danger of its extending to the 
neck is greater. But it is principally when its seat is in the an- 
terior part of the withers that the prognosis becomes alarming, as 
there the spinous processes are less prominent, the muscles thick- 
er and more complicated in their arrangements, and the cartilage 
of the scapula nearer, all these being conditions which render the 
discharge of the pus more difficult and the pui'ulent infiltrations 
more likely to take place, and where also counter-openings are 
made with more difi&culty, and indeed become almost impossible 
if the purulent accumulations are situated on the inside of the 
scapula or its cartilage of prolongation. 

It may be said, in fact, that the most important factor in the 
prognosis of this disease is the distance which separates the apex 
of the spinous processes of the vertebrae from the superior border 
of the cartilage of the scapula ; the chances of recovery being in 
the ratio of the distance between those two points. It is thus 
that it becomes less grave in well-bred animals, with elevated pro- 
jecting withers, than in low draught horses in which that region 
is depressed and thick, and the projection of the dorsal processes 
often replaced by a deep groove, bound on each side by the pro- 
jection of the muscles and of the border of the scapular cartilage. 
The disease is also of less gravity in young animals, except when 
they are under the influence of distemper. 

The treatment required in fistulous withers includes two prin- 
cipal indications : 1st. To facilitate the escape of the pus and 



776 DISEASES OF THE WITHERS. 

obviate its action upon the tissues with which it comes in contact 
and prevent its necrosing influence, and second to accelerate the 
eHmination of the necrosed parts. 

The first indication is fulfilled in enlarging the fistulas to the 
greatest extent possible. This is done with the straight bistoury 
carried in the groove of the director or of the S probe, introduced 
into the tract as far as possible. But when the fistula runs ob- 
liquely downward and inward, and has become complicated with 
diverticulums which run into the depths of the tissues, this en- 
largement of the fistula is more difficult, inasmuch as it necessi- 
tates too extensive a division of tissues for safety. This difficulty 
is obviated by estabUshing counter-openings at points correspond- 
ing with the bottom or cul-de-sac of the fistula. 

The situation of these counter-openings must be carefully cal- 
culated in order to make the drainage perfect. The instruments 
most suitable are the dog seton needle, a curved trocar, or prefer- 
ably the S probe, and a straight bistoury. The openings must 
be liberal to assure the best results, and they must be prevented 
from contracting or too rapidly closing, and so checking the pur- 
ulent flow either by the introduction of a tent of oakum or other 
permeable foreign substance, or, and it is much the better method, 
by the use of a drainage tube similar to the India rubber irriga- 
tion tube. This implement, besides fulfilling all the other indica- 
tions desired, possesses the additional advantage of facilitating 
the injection of fluid detergents or curatives into the fistulous 
tract. When the drainage has become well established irrigations 
must be made two or three times daily as long as may be neces- 
sary. The fluids best adapted as being both detergent and cura- 
tive in their nature are pure tepid water, phenicated water (five 
per cent, solution), or permanganate of potash solution (one to 
two per cent.), or again simple alcoholic water. The irrigation 
can be made with an ordinary syringe. Peuch and Toussaint, 
however, say " that when the circumstances allow it cold water in 
continued irrigation constitutes the best medication and that 
which prevents most certainly all complications. On that account 
they cannot recommend it too strongly." 

While this form of treatment is usually successful in oases of 
lesser severity, there are many instances in which they become 
powerless, and other means become necessary for the removal of 
the necrosed part. In times gone by caustics, in both the solid 



DISEASES OF THE WITHERS. 777 

and liquid form, were held in high repute, even in the form of 
actual cauterization, as recommended by Lafosse. In later times, 
however, the serious effects which followed theu' appUcation caused 
them to be ignored. Preparations of lesser severity were then 
recommended, among which were Villate's solution ; those of the 
sulphates of copper or of zinc, in various degrees of strength; 
of tincture of iodine, of spirits of turpentine, of nitrate of silver, 
and even of tartar emetic, and their use was followed by good 
results. 

Cantharides ointment, appHed externally over the swelling, 
and by injections into the fistulous tract, after being diluted with 
tincture of cantharides, is also recommended. 

"When the pus has filtrated inside of the shoulder, Bouley and 
Nocard suggest the propriety of " attempting to lacerate with a me- 
tallic rod the cellular tissue of the internal face of the shoulder, so 
as to produce an abscess by congestion, whose opening, which must 
be made wide, would allow the escape of the pus, and the possible 
frequent cleansing of the enormous fistula thus formed. By this 
process one might avoid the serious accidents likely to result from 
the sejoum of the pus, and its fermentation from the contact of 
the tissues." 

For cases like these Lafosse recommended the trephining of 
the scapula — a very serious operation. It is said to have been 
successful with him, but it must be a difficult matter to perform 
it properly in such a manner that the trephine is appHed at a point 
on the surface exactly corresponding to the bottom of the fis- 
tula. 

When all means of so stimulating the action of the parts as 
to effect the arrest of the necrosis, and the sloughing of the morti- 
fied structure have failed, there is but one alternative left, and 
that is the direct amputation of the apex of the spinous process, 
and the excision of the diseased portion of the ligament. But 
this operation, indicated by Lafosse, is possible only when the 
disease is limited to the apex of the most prominent spinous pro- 
cesses. It is positively contra indicated in low and thick withers, 
in which the wound left after the operation would be a hollow, 
cup-shaped depression, from which the pus would naturally gravi- 
tate and filtrate in all directions. 

The instruments necessary for this operation are : A grooved 
director, curved and straight bistouries, sage-knives, sharp draw- 



778 DISEASES OF THE WITHEES. 

ing knives, bull-dog forceps, and an amputating saw; and with 
these the appliances usually needed in the way of hemostatics, 
and the necessary dressings, artery forceps, oakum, sponges, 
drainer-tubes, dog seton needles, etc. The various steps of the 
operation are thus described by Peuch and Toussaint : 

"Everything being ready, the operator enlarges the fistulous 
tract, simple or ramified as it may be, so as to expose the ne- 
crosis. In making this special attention must be taken to give 
the incision a direction favorable to the escape of the pus. This 
first step of the operation is accompanied with abundant hemor- 
rhage, which must first of all be arrested either by ligating the 
divided blood vessels, or by plugging the wound with oakum 
moistened with a solution of perchloride of iron. The hemor- 
rhage stopped, and the necrosis exposed, the second step, and the 
important one of the operation, is proceeded with. To effect this 
the necrosed surface is limited by a double incision, made with a 
sharp instrument, straight bistoui*y, or sage-knife. This incision 
involves the entire thickness of the cervical ligament and the fibro- 
cartilage covering the apex of the sj)inous process and passing 
under this cartilage. In making this incision the operator must 
be careful not to injure any of the other processes if they are not 
diseased. This done, with the sage-knife the deepest layers of 
the cartilage are excised, and then, with the drawing knife, the 
bony tissue underneath is resected so as not to leave the smallest 
particle of necrosed tissue. Here, as in some cases of foot opera- 
tion, not only must all the diseased tissue be removed, but some 
of the healthy structures. The resection of the apex of the ne- 
crosed processes can be made with the saw instead of the draw- 
ing knife. But this instrument is preferable, as it is easier to 
manipulate and it always leaves a smooth wound." 

The subsequent treatment is of the routine kind. The parts 
are, of course, thoroughly cleansed ; the hemorrhage is controlled 
by pressure, a drain tube is secured at the lower angle of the 
wound, and the edges are brought together by quilled sutures. 
Eepeated injections of phenicated water are passed through the 
drainage tubes, and the patient is watched in order to prevent him 
from injuring himself by rubbing. If the season and the circum- 
stances permit, continued irrigation is established. 

Toward the fourth or fifth day the sutures are removed and 
the dressing changed. The granulating process is carefully 



DISEASES OF THE WITHERS. 779 

watched, and its progress kept under control by mild caustic ap- 
plications, or by pressure, to prevent an uneven and too rapid 
cicatrization 

During the treatment the animal must be kept quiet, and even 
in some cases it will be prudent to hobble his fore legs in order to 
limit his movements and prevent the filtration of the pus under 
the shoulder. He is to be kept on light and nutritive diet, to 
compensate for the losses resulting from the abiindant suppura- 
tion, and when the disease has disappeared, and there is only a 
superficial wound remaining, and no more fear of returning com- 
pHcations or relapses, the animal can be returned to his labors, 
but must make his adieus to the bulky collar which has weighed 
so heavily on his neck, and substitute for it the equally efficient 
and far more sightly Dutch coUar, which has never yet in any way 
contributed to bring upon its wearer the calamity of diseased 
withers. 

DISEASES OF THE POLL. 

This region of the neck is the seat of lesions, frequently occur- 
ring, and of varying nature. They include excoriations, oedema- 
tous swellings, cores, cysts, bloody tumors, abscesses, bruises, 
wounds, etc., any of which may become complicated, and termi- 
nate in 2^oll evil, or the necrosis of one of the fibrous, elastic, or 
bony elements which enter into the composition of that region. 

Li considering the anatomical structure of the portion of the 
neck in question we find on the to}) a mass of hair, separated from 
that of the superior border of the neck by a surface which has 
become callous by the constant frictions of the head-strap of the 
halter or of the bridle; the skin (Fig. 563), thick on the median 
line, thinner on the sides, but always loosely connected with the 
subjacent tissues; a thick layer of Connective tissue, more or less 
infiltrated with fat, and lardaceous in low-bred horses ; the cord of 
the ligamentum nuchse, which is attached to the occipital bone, 
and more or less covered by the cervico-auricularis muscles ; on 
each side, and on the same level, the terminal insertion of the 
splenitis muscles, and forming an elevation which is covered by 
the aponeurosis common to that muscle and the small complexus, 
which itself makes an apparatus of retention of great resistance 
to the organs of the region ; then another layer, composed of the 
large tendon of the great complexus, the small oblique muscle of 



780 



DISEASES OF THE POLL. 




Pig. 563.— Section of the Neck on a Level with the Poll, 
p.— The skin, tc— Lardaceous connective tissue on the top of cervical ligament, 
gc— Superior extremity of the great complexus and small oblique muscle of the head. 
Ic— Ligament nuchse. dp.— Posterior straight muscles of the head, lao.— Atloido- 
occlpital ligament. Is. — Superior part of the atlas, sm.— Rachidian dura mater, 
m.— Spinal marrow, ta.— Adipose tissue of the rachidian canal, a.— Atlas, ph.— 
Pharynx, go.— Section of the great oblique muscle of the head, ao.— Section of odon- 
toid process of the axis, p.— Parotid gland, sm.- Sub-maxillary gland, da.— Anterior 
Btraight of the head 00.— CEsophagus. 

the head, the great oblique, and under them, the posterior straight 
muscles of the head; a serous sac, assisting the gUding of the 
cord of the ligamentum nuchse over the atlas, which is very small 
in yoimg animals, assumes larges dimensions in old subjects ; and, 
finally, a skeleton of the region, the atlas, the axis and the occi- 
pito-atloid' and atloido-axoid articulations. Two large arteries are 
distributed throughout the locality, the occipito-museular and the 
atloido-muscular. 

The causes in which diseases of the poll originate are numer- 
ous. Among them may be mentioned first, bruises, from blows 
given with the handle of a whip, or of a fork; contusions and 
continued frictions against hard substances, as the manger; the 
pressure and rubbiag of the parts of the harness (the bridle, etc.), 
which pass over that region; the repeated rubbing which the ani- 
mal inflicts upon himself when he is aflfected with parasitic cuta- 
neous* disease; the blows which he receives when in tossing his 
head, he brings it in contact with the ceiling of his stable, when 
this is too low, and he has formed the habit of puUing back on 
the halter; the spreading of diseases of the neck by the extension 
of the necrosis of the cord of the cervical ligament, all these are 



DISEASES OF THE POLL. 781 

considered to be so many active agencies in the etiology of poll 
evil. 

In cattle it is most commonly chargeable to the pressure and 
frictions of the yoke. Hertwig, with other German authors, con- 
siders it, and particularly the sus-atloid hygroma, as the local mani- 
festation of a diathesic condition, such as rheumatism and dis- 
temper. They also admit that the true poll evil may develop itself 
spontaneously, and independently of all other traumatic causes. 

In considering the various forms which the disease may assume 
in this locality we shall adopt the division sanctioned by Bouley, 
who has thus arranged them. 

A — Excoriations; B — (Edematous Swellings; C — Core; 
D — Bloody Tumors. 

Diseases of the poU, in horses, exhibit too close a resemblance 
in their type and general history to escape notice, and the ther- 
apeutic indications exhibited in them are the same. And it must 
be borne in mind that however slight they may appear to be, and 
whatever may be their nature, they always require immediate at- 
tention and careful watching, and in all cases the use of the bridle 
and the halter must be suspended. 

E. — Cyst. 

Cysts of the poll are divided into superjicial and deej). The 
former, which are of uncommon occurrence, have their seat in the 
subcutaneous cellular tissue, and possess features in common with 
those which appear at the withers. The latter is an abnormal 
dilatation of the serous sac which facihtates the gliding of the 
cervical cord upon the atlas ; it is also known as the atloid hy- 
groma. It generally begins suddenly, and is manifested by the 
presence of a soft tumor, fluctuating, spherical, or bilobulated by 
the median pressure of the cervical ligament. It is usually pain- 
less, except when it is the result of acute violence, in which case 
it may be accompanied with inflammatory symptoms, which may 
extend to suppuration, but in such cases, which, however, are in- 
frequent, there is also a degree of fever corresponding in intensity 
with the other features of the case. The fluctuation is at first 
uniform, and easily detected, but at a later period, as the secre- 
tion becomes more abundant, and the tension of the pouch be- 



782 DISEASES OF THE POLL. 

comes greater, and the thickening of the walls progresses, it be- 
comes obscure. 

In the stable the animal is very quiet, standing with the neck 
extended and the head carried downward ; he moves with difficulty, 
without raising the head, and avoiding all movements of the 
muscles of the neck, and especially of the extensors. At times 
the distension of the walls of the cyst may be so extreme that 
the capsular hgament of the occipito-atloid joint is pushed in- 
ward in the rachidian canal, and when this occurs nervous symp- 
toms appear, caused by the pressure of the rachidian bulbs. 

If unremedied, it assumes a chronic condition, with progres- 
sive distension, which may end in death by pressxire uj)on the 
bulb. Purulent transformation, and poll evil proper, are also the 
possible terminations of the atloid hygroma; indeed, it is only in 
rare instances that it is known to subside by resolution or resorp- 
tion. In cases of doubtful diagnosis as to the formation of cystic 
or purulent collections, exploration wOl relieve the doubt, and at 
once settle the question of treatment. 

Blistering and absorbing appHcations, often repeated, and 
combined with aspiration, have often reheved the atloid hygroma. 
Cauterization in lines or points, both superficial and deep, are 
also recommended. Injections of tincture of iodine have also 
their supporters, but they are sometimes liable to give rise to vio- 
lent irritation, ending in purulent collections, and perhaps necrosis 
possibly of the cervical ligament. 

F. — Abscess. 

This is the most frequent lesion of the poll, forming at once, 
when the exciting cause is sufficiently active, or when originating 
in the manner already described. 

It consists at first, of a diffused, not well defined, swelling of 
the abundant cellular tissue which separates the muscles of the 
region, to coalesce at a later period, to form a single purulent 
gathering, but not until it has macerated and destroyed all the 
intermediate tissues into which it had become infiltrated, and this- 
destructive process advances so actively and persistently that when 
it reaches the surface, instead of closing up, the abscess has be- 
come transformed into a fistulous center, with a constant dis- 
charge of mortified, fibrous, elastic, or bony structure. 



DISEASES OF THE POLL. 783 

The establishment of the suppurative process, even before 
any local symptoms have been manifested, is betrayed by the 
changed appearance of the animal. As described in the previous 
pages, he becomes Hstless and dull, standing qviietly with the 
neck extended and the head resting on the manger; refusing to 
move, or if doing so, never raising his head, and by grunts and 
moans betraying the great pain he is suffering. If his head be 
raised by force he rebels against it, struggles, goes backward, 
strikes with his fore feet, and perhaps rears. 

By bringing the animal imder control and restraint, as by 
throwing him, the abscess may be easily discovered, on one side 
of the neck, as a diffused swelling, tense, warm, and so excessively 
sensitive to the shghtest contact, that it is with the greatest diffi- 
culty that an obscure and deep fluctuation can be detected. The 
positive nature of this tumor must then be made out as early as 
possible, by repeated capillary explorations, since if discovered to 
be unmistakably of a suppurative nature, a free exit to the pus 
must be at once established, to avoid its necrotic tendency ; while 
if it be a cyst, there is danger in opening it, arising from its lia- 
bility to be followed by necrosis of the cervical ligament. 

The prognosis of this abscess will vary according to the 
length of time which may have elapsed between its incejation and 
its detection. The serious nature of this prognosis is explained 
by the fact of the incompressibUity of the pus and the inextensi- 
bihty of the aponeurosis of the splenius and complexus muscles, 
which resist the sweUing of the inflamed tissues, and by their 
compression and strangulation, become the cause of gangrene. If 
a diagnosis of abscess is made, and it is immediately opened, the 
cavity may assume the character of an ordinary abscess, and close 
entirely ; but this is a rare termination. More ordinarily, the incar- 
ceration of the infiltrated pus between the muscular layers is an 
obstacle to its free and complete discharge, and it remains infil- 
trated, gathering into cul-de-sacs, and migrating irregularly be- 
tween the muscles. Hence the formation of so many fistulous 
tracts, opening at diverse points on the skin, which are generally 
the result of the necrosis of the Hgamentum nuchse, or of the 
fibrous tissue of the tendons, or even of that of the atlas, or 
possibly of the occipital bone. 

All the dangers which are likely to follow the existence of an 
abscess at the poll, demonstrate the necessity for prompt surgi- 



784 DISEASES OF THE POLL. 

cal interference. Whenever the presence of the pus is established 
the abscess must be opened, and opened very freely. This must 
be carefully done. The puncture must be made in the center of 
the tumor, and after the evacuation of the pus it must be ex- 
tended with the bistoury, introduced with the aid of a grooved 
director, and making, of course, a counter-opening at the most 
dependent point. This incision should be made parallel with the 
cervical ligament, and must be carefully made, in order to avoid 
wounding the capsular ligament of the joint, or the occipito-mus- 
cular artery. 

The hemorrhage which accompanies this operation is easily 
controlled by pressiire. Antiseptic dressings, with the use of a 
drainage tube constitute the after-treatment, which must be similar 
to that of the same diseases at the neck and at the withers, with 
the difference, perhaps, that the dressings and cleanings must be 
oftener renewed. 

If no complications arise the wound will heal without diffi- 
culty, and the animal may be able to resume work after two or 
three weeks' recuperation. 

Poll Evil. 

But if, on the contrary, the animal is suffering with the per- 
sistent and tenacious lesion which consists in the necrosis of the 
yellow or white fibrous tissue of the region, or a diseased condi- 
tion of the suiTounding bones, we are confronted with the very 
serious affection commonly known as poll evil. 

This disease originates, ordinarily, in one of those already con- 
sidered, and yet it may appear spontaneously, if the instigating 
traumatism from which it grew has been sufficiently severe or 
violent. And, again, it may be a sequelae or extension of a similar 
diseased process in the neck. 

Its characteristic appearance is that of a large induration, de- 
veloped around one or several fistulous tracts, from which escapes 
a thin, sanious pus, of foetid odor. Upon being exploi*ed these 
fistulas are found to vary in their direction, in their depth, and in 
the tissue on which they terminate. Exploring with the probe, 
or, more certain, with the finger, a cavity is found more or less 
filled with pus, with granulating walls, in the bottom of which 
the cervical ligament is felt, isolated, roughened and more or less 
escharrified, or, if this chord has remained intact, it will indicate 



DISEASES OF THE POLL. 785 

that the seat of the lesions is the tendon common of the splenius, 
or of the complexus, or, perhaps, of the obUque or posterior 
straight muscles. 

At an advanced period, when the progress of the mortification 
has been for some time unchecked, and the bony insertions of the 
hgament, or of the tendons, have become affected, the surfaces of 
these bones also become affected and their roughened or possibly 
necrotic character is readily recognized by the exploring finger. 

It may also happen that the capsular ligament of the joint, 
constantly macerated in the pus, softens and yields, and the pene- 
tration of the discharge into the vertebral canal soon ends the 
case by the rapid development of suppurative cerebro-spinal men- 
ingitis. 

Hertwig and Lafosse have reported instances where anchylosis 
of the occipito-atloid joiat had taken place. 

There is in the museum of the American Veterinary College a 
preparation of an anchylosis of the occipito-atloid articulation 
which undoubtedly is the result of a case of chronic poll evil. 

The prognosis of this ailment is always serious. A sKght 
lesion may grow and develop into a case, with all its dangers. 
For this reason a cautious expression of opinion on the part of 
the siu'geon is equally due to considerations of policy as to the 
obHgations of truth. 

The treatment is essentially and exclusively surgical. 

In the simplest cases free openings and ample drainage of the 
wound, with plenty of washing and antiseptic attention will con- 
trol the trouble. 

In more severe cases, where the presence of the fistulous 
tracts is stimulated by the indm-ation of the parts, and the con- 
stant movements of theu' walls, the external apphcation of a 
strong bhster and the injection iato the fistulee of tinctui-e of 
iodine, or of cantharides, or of solutions, more or less concen- 
trated, of tartar emetic, nitrate of silver, chloride of ziac, etc., 
will contribute to immobihze the parts and stimulate the granu- 
lating and healing process. 

The section of the cord of the ligamentum nuchse is indicated 
when the tension of the region becomes too rigid, and the pain inor- 
dinate. This alleviating measure was first instituted by Langen- 
bacher and Hertwig in Germany ; then by Lafosse and Rey in 
France, and it has always given excellent results. It relieves the 



786 DISEASES OF THE POLL. 

pressure and the pain, obviates the danger of gangrene, facilitates 
the examination of the wound, and greatly aids the excision of 
the soft, necrosed tissues, and the scraping of their bony attach- 
ments. 

The operation is simple. The patient is thrown, and a straight 
bistoury, or in preference, a bliuit curved tenotomy knife are the 
instruments. With the latter, the division of the skin is avoided. 
The hgamentous section is subcutaneous, the instrument being 
introduced under the cord, and the division made from within 
outward. When the section is made, the ends of the ligament 
draw apart. If it is necrosed, the anterior stump is removed down 
to its insertion in the occipital bone, which may also be scraped. 
The same treatment is applied to the tendons of the muscles. In 
fact, the opening is cleared from all mortified substances, and 
treated as a simple wound. 

After the operation, the animal carries his head low down and 
vertical, but when the wound becomes cicatrized, and continuity 
is re-established between the stump of the ligament and the cervi- 
cal tuberosity, the head becomes by degrees elevated, and is event- 
ually restored to its normal position and natural liberty of motion. 



